胸腔镜手术治疗先天性肺畸形：既往感染真的重要吗？

Thoracoscopic surgery for congenital lung malformations: Does previous infection really matter?

机构信息

Department of Pediatric Surgery, AP-HP, Necker-Enfants malades Hospital, Paris, France; Department of Pediatric Surgery, Mansoura University Children's Hospital, Mansoura, Egypt.

Department of Pediatric Surgery, Mansoura University Children's Hospital, Mansoura, Egypt.

出版信息

J Pediatr Surg. 2021 Nov;56(11):1982-1987. doi: 10.1016/j.jpedsurg.2021.01.036. Epub 2021 Jan 27.

DOI:10.1016/j.jpedsurg.2021.01.036

PMID:33573805

Abstract

BACKGROUND/ PURPOSE: Elective resection of congenital lung malformations (CLMs) is still debatable. The two main risks are malignant transformation and recurrent pulmonary infections. Our study aimed to assess the effect of previous pulmonary infection on the intraoperative and postoperative courses of thoracoscopic surgery for CLMs.

METHODS

This is a retrospective study including all thoracoscopic lung resections for CLMs between 2010 and 2019. Ninety patients were included. There was a history of previous pulmonary infection in 28 patients (group A) and no such history in 62 patients (group B).

RESULTS

The median age at operation for group A was 20.4 months (IQR:14.9-41.4) versus 15.1 months (IQR:9.7-20.8) in group B (p = 0.006). There were 10 conversions (35.7%) in group A and 8 (12.9%) in group B (p = 0.02). The operative time was significantly shorter in group B (p<0.002). In group A, 32.1% of patients experienced postoperative fever versus 11.3% of group B (p = 0.03), with higher antibiotics requirement (28.6% versus 6.5% respectively, p = 0.007). However, no significant differences were found in terms of postoperative complications (p = 0.99).

CONCLUSION

Earlier intervention for CLMs before the development of pulmonary infection carries higher chances for the success of the thoracoscopic approach with shorter operative time and more uneventful postoperative courses.

摘要

背景/目的：择期切除先天性肺畸形（CLM）仍存在争议。两个主要风险是恶性转化和复发性肺部感染。我们的研究旨在评估先前肺部感染对 CLM 胸腔镜手术术中及术后过程的影响。

方法

这是一项回顾性研究，包括 2010 年至 2019 年期间所有 CLM 的胸腔镜肺切除术。共纳入 90 例患者。28 例（A 组）有先前肺部感染史，62 例（B 组）无肺部感染史。

结果

A 组的手术年龄中位数为 20.4 个月（IQR：14.9-41.4），B 组为 15.1 个月（IQR：9.7-20.8）（p=0.006）。A 组中有 10 例（35.7%）中转开胸，B 组中有 8 例（12.9%）中转开胸（p=0.02）。B 组的手术时间明显更短（p<0.002）。A 组中有 32.1%的患者术后发热，B 组中有 11.3%（p=0.03），需要更多的抗生素（分别为 28.6%和 6.5%，p=0.007）。然而，两组在术后并发症方面无显著差异（p=0.99）。