Pediatric Surgery Unit, "Federico II" University of Naples, Naples, Italy.
Pediatric Surgery Unit, Robert Debrè Hospital, Paris, France.
J Laparoendosc Adv Surg Tech A. 2021 Mar;31(3):355-362. doi: 10.1089/lap.2020.0596. Epub 2021 Jan 11.
This study aimed to report a European multi-institutional experience about thoracoscopic management of children with congenital lung malformations. The records of 102 patients (49 girls and 53 boys) with median age at surgery of 1 year (range 6 months-1.5 years), who underwent thoracoscopic lobectomy in five European Pediatric Surgery units, were retrospectively collected. Indications for surgery included congenital pulmonary airway malformation (CPAM) ( = 47), intra- and extralobar pulmonary sequestration ( = 34), hybrid lesion (CPAM/intralobar sequestration) ( = 2), severe bronchiectasis ( = 9), congenital lobar emphysema ( = 8), and others ( = 2). The condition was asymptomatic in 77/102 (75.5%), whereas symptoms such as recurrent pneumonia and/or respiratory distress were present in 25/102 (24.5%). Surgical procedures included 18 upper, 20 middle, and 64 lower lobe resections. No conversions to open were reported. A 3 mm sealing device and 5 mm stapler were adopted in the last 48/102 patients (47%). The median operative time was 92.2 minutes (range 74-141). The median operative time significantly decreased in patients in whom the vessel division and bronchial sealing were performed using sealing devices (75.5 minutes) compared with suture ligations (118.9 minutes) ( = .001). The median hospital stay was 3.7 days (range 2-6.2). Three/102 patients (2.9%) developed postoperative complications, including air leakage requiring pleural drainage ( = 1) (Clavien IIIb) and respiratory infection ( = 2) (Clavien II). A reoperation was required in one patient with residual pleuropulmonary blastoma (0.9%). All symptomatic patients reported resolution of symptoms postoperatively. Thoracoscopic lobectomy is a safe and effective procedure with excellent cosmetic outcome, in expert hands. Based upon our experience, we strongly recommend surgery in patients with congenital lung malformations by the first year of life, to reduce the risk of infection and make the procedure technically easier, despite the small patients' size. Surgeon's experience and use of miniaturized instruments and sealing devices remain key factors for successful outcome.
本研究旨在报告一项欧洲多机构经验，即胸腔镜治疗儿童先天性肺畸形。回顾性收集了五个欧洲小儿外科单位的 102 名患者（49 名女孩和 53 名男孩）的记录，这些患者的中位手术年龄为 1 岁（6 个月至 1.5 岁），均接受了胸腔镜肺叶切除术。手术指征包括先天性肺气道畸形（CPAM）（ = 47）、肺内外隔离（ = 34）、混合病变（CPAM/叶内隔离）（ = 2）、严重支气管扩张症（ = 9）、先天性大叶性肺气肿（ = 8）和其他（ = 2）。102 例中有 77 例（75.5%）无症状，而 25 例（24.5%）有反复肺炎和/或呼吸困难等症状。手术包括 18 例上叶切除术、20 例中叶切除术和 64 例下叶切除术。无中转开胸。最后 48/102 例（47%）采用 3 毫米密封装置和 5 毫米吻合器。中位手术时间为 92.2 分钟（74-141 分钟）。使用密封装置进行血管分离和支气管密封的患者手术时间中位数为 75.5 分钟，明显短于缝线结扎的患者（118.9 分钟）（ = .001）。中位住院时间为 3.7 天（2-6.2 天）。3/102 例（2.9%）发生术后并发症，包括需要胸腔引流的气胸（ = 1）（Clavien IIIb）和呼吸道感染（ = 2）（Clavien II）。1 例残余肺胚细胞瘤患者需要再次手术（0.9%）。所有有症状的患者术后症状均得到缓解。在专家手中，胸腔镜肺叶切除术是一种安全有效的手术，具有极好的美容效果。根据我们的经验，我们强烈建议在儿童生命的第一年对先天性肺畸形患者进行手术，以降低感染风险，并使手术在技术上更容易，尽管患者体型较小。外科医生的经验以及使用小型仪器和密封装置仍然是手术成功的关键因素。
