Luo Dengke, Fu Xiaoying, Wang Qinghai, Cheng Kaisheng, Lv Yong, Yuan Miao, Xu Chang, He Taozhen, Yang Gang, Wang Yao, Jia Ru, Liu Chenyu
Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, China.
Department of Pediatric Surgery, Guangyuan Central Hospital, Guangyuan, China.
J Laparoendosc Adv Surg Tech A. 2022 Dec;32(12):1293-1298. doi: 10.1089/lap.2022.0078. Epub 2022 Oct 18.
Thoracoscopic lobectomy is a challenging procedure in children with congenital lung malformations (CLMs). This study aims to evaluate the safety and efficacy of thoracoscopic clockwise lobectomy (TCL) in CLMs in children and its potential to be a stylized procedure. All patients with CLMs who received TCL from 2015 to 2019 in our hospital were retrospectively reviewed. Clinical information was extracted from medical records, including patient demographics, operative details, and outcomes. A total of 184 patients with a median age of 6.8 months (range, 3-156) and a median weight of 9 kg (range, 6-45) received TCL. Lesions were all located in the lower lobe and included congenital pulmonary airway malformation ( = 133), intralobar sequestration ( = 44), bronchiectasis ( = 4), and congenital lobar emphysema ( = 3). The mean (±standard deviation [SD]) operating time was 46 ± 7.5 minutes (range, 35-113). The mean (±SD) blood loss was 3.5 ± 0.8 mL (range, 1-60). Three patients converted to thoracotomy, and 162 patients did not have a chest tube placed. The postoperative course was uneventful in all patients except 2 patients who developed air leaks and 23 patients who developed a mild fever. The median length of postoperative hospital stay was 2 days. A total of 163 patients were followed up for more than 1 year without any complications. TCL is suitable for lower lobectomy and is safe and effective in standard and complicated thoracoscopic lobectomy. It could be recommended as a stylized procedure in treating children with CLMs.
胸腔镜肺叶切除术对于患有先天性肺发育畸形（CLMs）的儿童来说是一项具有挑战性的手术。本研究旨在评估胸腔镜顺时针肺叶切除术（TCL）在儿童CLMs中的安全性和有效性，以及其成为标准化手术的潜力。对2015年至2019年在我院接受TCL的所有CLMs患者进行回顾性分析。从病历中提取临床信息，包括患者人口统计学资料、手术细节和结果。共有184例患者接受了TCL，中位年龄为6.8个月（范围3 - 156个月），中位体重为9kg（范围6 - 45kg）。病变均位于下叶，包括先天性肺气道畸形（n = 133）、叶内型肺隔离症（n = 44）、支气管扩张（n = 4）和先天性大叶性肺气肿（n = 3）。平均（±标准差[SD]）手术时间为46±7.5分钟（范围35 - 113分钟）。平均（±SD）失血量为3.5±0.8mL（范围1 - 60mL）。3例患者中转开胸，162例患者未放置胸管。除2例出现漏气和23例出现低热外，所有患者术后恢复顺利。术后中位住院时间为2天。共有163例患者随访超过1年，无任何并发症。TCL适用于下叶切除术，在标准和复杂的胸腔镜肺叶切除术中安全有效。可推荐作为治疗儿童CLMs的标准化手术。
