Guo Rui, Zhai Yunpeng, Zhang Shisong, Zhao Huashan, Xu Hongxiu, Lv Longfei
Department of Thoracic and Tumor Surgery, Children's Hospital Affiliated to Shandong University, Jinan, China.
Department of Thoracic and Tumor Surgery, Jinan Children's Hospital, Jinan, China.
Front Pediatr. 2022 Aug 18;10:934827. doi: 10.3389/fped.2022.934827. eCollection 2022.
The present study aimed to evaluate the safety and feasibility of modified thoracoscopic wedge resection of limited peripheral lesions in the posterior basal segment (S10) in children with congenital pulmonary airway malformation (CPAM).
We retrospectively analyzed the clinical data of children with CPAM who underwent thoracoscopic modified wedge resection at our institution from November 2020 to February 2022. The surgical method was as follows: we marked the external boundary of the lesion with an electric hook, dissected and retained the segmental vein between the lesion and normal lung tissue as the internal boundary, cut the arteries, veins, and bronchus entering the lesion, and cut and sealed the lung tissue between the internal and external boundaries with LigaSure™ to complete the modified wedge resection.
A total of 16 patients were included, aged 3.8-70.0 months and weighing 6.5-21.0 kg. The intraoperative course was uneventful in all patients. The median operation time and intraoperative bleeding volume were 74 min (50-110 min) and 5 mL (5-15 mL), respectively. The median postoperative drainage tube indwelling time was 3 days (2-4 days), and the median postoperative hospital stay was 6 days (4-8 days). Pathological diagnosis included two cases of type 1, 10 cases of type 2, and four cases of type 3 CPAM. There were no cases of intraoperative conversion, surgical mortality, or major complications. However, subcutaneous emphysema occurred in two children, which spontaneously resolved without pneumothorax orbronchopleural fistula development. All patients were followed up for a median period of 10 months (3-18 months), and there were no cases of hemoptysis or residual lesions on chest computed tomography.
Modified thoracoscopic wedge resection the inferior pulmonary ligament approach is safe and feasible for children with CPAM with limited peripheral lesions in S10.
本研究旨在评估改良胸腔镜楔形切除术治疗先天性肺气道畸形（CPAM）患儿后基底段（S10）局限性周边病变的安全性和可行性。
我们回顾性分析了2020年11月至2022年2月在我院接受胸腔镜改良楔形切除术的CPAM患儿的临床资料。手术方法如下：用电钩标记病变的外部边界，在病变与正常肺组织之间解剖并保留段静脉作为内部边界，切断进入病变的动脉、静脉和支气管，并用LigaSure™切割并封闭内外边界之间的肺组织，完成改良楔形切除术。
共纳入16例患者，年龄3.8 - 70.0个月，体重6.5 - 21.0 kg。所有患者术中过程均顺利。中位手术时间和术中出血量分别为74分钟（50 - 110分钟）和5毫升（5 - 15毫升）。术后引流管中位留置时间为3天（2 - 4天），术后中位住院时间为6天（4 - 8天）。病理诊断包括1型2例，2型10例，3型CPAM 4例。无术中中转、手术死亡或严重并发症发生。然而，2例患儿出现皮下气肿，未发展为气胸或支气管胸膜瘘而自行消退。所有患者中位随访10个月（3 - 18个月），胸部计算机断层扫描未见咯血或残留病变病例。
改良胸腔镜楔形切除（下肺韧带入路）治疗S10局限性周边病变的CPAM患儿是安全可行的。
