Department of Neonatal and Pediatric Surgery, Chancheng District, Foshan Women and Children Hospital Affiliated to Southern Medical University, No. 11 West Renmin Rd, Foshan City, 528000, Guangdong, China.
Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, Guangdong, China.
BMC Pulm Med. 2021 Mar 12;21(1):82. doi: 10.1186/s12890-021-01445-2.
The purpose of this study is to evaluate the potential advantages of thoracoscopic versus open resection for symptomatic congenital pulmonary airway malformation (CPAM) in neonates.
A retrospective review of the medical records of neonates (age ≤ 28 days) who underwent surgery for symptomatic CPAM from 2010 to 2020.
Of the 24 patients, 14 patients underwent thoracoscopic resection and 10 patients underwent open resection. 4 patients with CPAM located in the upper or middle lobes underwent lobectomy, and 20 underwent lung-preserving wedge resection in the lower lobe. Between the two groups, there were no statistically significant differences in related preoperative variables, including gestational age at birth, body weight, head circumference, lesion size, cystic adenomatoid malformation volume ratio (CVR), and age at operation (P > .05). The differences in intraoperative variables were statistically significant. The length of the surgical incision was significantly shorter in thoracoscopic resection group than in open resection group (1.4 cm [1.3-1.8] vs. 6.0 cm [5.0-8.0], P = .000), along with significantly less operative blood loss (3 ml [1-6] vs. 5 ml [2-10], P = .030) but significantly longer operation time (159 min [100-220] vs. 110 min [70-170], P = .003). Regarding postoperative variables, ventilator days, duration of chest tube use and length of hospital stay were not statistically significant (P > .05).
Both thoracoscopic and open resection for symptomatic CPAM achieve good clinical outcomes, even in neonates. Thoracoscopic resection has minimal aesthetic effects and does not increase the risk of surgical or postoperative complications. Lung-preserving resection may be feasible for neonatal CPAM surgery.
本研究旨在评估胸腔镜与开胸手术治疗有症状先天性肺气道畸形（CPAM）新生儿的潜在优势。
回顾性分析 2010 年至 2020 年期间接受手术治疗有症状 CPAM 的新生儿（年龄≤28 天）的病历。
24 例患者中，14 例行胸腔镜切除术，10 例行开胸切除术。4 例 CPAM 位于肺上叶或中叶行肺叶切除术，20 例行肺下叶保留肺楔形切除术。两组相关术前变量（出生胎龄、体重、头围、病变大小、囊性腺瘤样畸形体积比（CVR）和手术年龄）无统计学差异（P＞.05）。术中变量差异有统计学意义。胸腔镜组手术切口长度明显短于开胸组（1.4cm[1.3-1.8] vs. 6.0cm[5.0-8.0]，P=0.000），术中出血量明显少于开胸组（3ml[1-6] vs. 5ml[2-10]，P=0.030），但手术时间明显长于开胸组（159min[100-220] vs. 110min[70-170]，P=0.003）。术后变量方面，呼吸机使用天数、胸腔引流管使用时间和住院时间差异无统计学意义（P＞.05）。
胸腔镜与开胸手术治疗有症状 CPAM 均可获得良好的临床效果，即使在新生儿中也是如此。胸腔镜切除具有最小的美容效果，并且不会增加手术或术后并发症的风险。对于新生儿 CPAM 手术，保留肺组织的切除术可能是可行的。
