Kuroda Yasuhiro, Fukuzawa Hiroaki, Kawahara Insu, Morita Keiichi
Department of Pediatric Surgery, Kobe Children's Hospital, Chuo-ku, Kobe, Japan.
European J Pediatr Surg Rep. 2021 Nov 24;9(1):e72-e75. doi: 10.1055/s-0041-1735807. eCollection 2021 Jan.
Fetal lung interstitial tumor (FLIT) is a rare primary lung mass in neonates. Classical incisions, such as posterolateral thoracotomy or median sternotomy, do not provide optimal exposure of the operative field for the resection of pediatric thoracic giant tumors. Herein, we report a rare case of a FLIT in a full-term male neonate, with complete resection achieved using a hemi-clamshell approach, which provided the required visualization of the operative field. The neonate was transferred to our hospital because of mild respiratory distress, which developed 18-hour after normal vaginal delivery. A mass in his right chest, without a midline shift, was observed on chest radiographs. Computed tomography showed a well-circumscribed solid anterior cervicothoracic mass, with a uniform density and no apparent cysts, diagnosed as a primary thoracic giant tumor. Once the patient was clinically stabilized, we proceeded with right upper lobectomy, using a hemi-clamshell approach, full sternotomy, and anterolateral thoracotomy, on postnatal day 22. Histopathologic examination revealed an 8.5 × 6.5 × 4.0 cm solid mass within the right upper lobe, which was diagnosed as a FLIT. His postoperative recovery was uneventful. The patient was followed up for 1 year, with no complaints or symptoms and no postoperative shoulder dysfunction. Gross total resection of primary thoracic giant tumors can be accomplished in neonates with optimal exposure of the chest cavity using a hemi-clamshell approach.
胎儿肺间质瘤（FLIT）是新生儿中一种罕见的原发性肺部肿块。经典的手术切口，如后外侧开胸术或正中胸骨切开术，对于小儿胸部巨大肿瘤的切除并不能提供最佳的术野暴露。在此，我们报告一例足月儿男性新生儿患FLIT的罕见病例，采用半蛤壳式入路实现了完整切除，该入路提供了所需的术野可视化。该新生儿因正常阴道分娩18小时后出现轻度呼吸窘迫被转诊至我院。胸部X线片显示其右胸有一肿块，无中线移位。计算机断层扫描显示一个边界清晰的实性颈胸前部肿块，密度均匀，无明显囊肿，诊断为原发性胸部巨大肿瘤。患儿临床情况稳定后，于出生后第22天采用半蛤壳式入路、全胸骨切开术和前外侧开胸术进行了右上肺叶切除术。组织病理学检查显示右上叶内有一个8.5×6.5×4.0 cm的实性肿块，诊断为FLIT。其术后恢复顺利。对该患儿进行了1年的随访，无任何不适或症状，也无术后肩部功能障碍。采用半蛤壳式入路，在胸腔得到最佳暴露的情况下，可对新生儿原发性胸部巨大肿瘤进行根治性切除。
