Shiiya Haruhiko, Kaga Kichizo, Ujiie Hideki, Fujiwara-Kuroda Aki, Muto Jun, Nomura Shunsuke, Honda Shohei, Kato Tatsuya
Department of Thoracic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
J Thorac Dis. 2023 Sep 28;15(9):5020-5028. doi: 10.21037/jtd-23-515. Epub 2023 Sep 18.
In the last few decades, reduced-port video-assisted thoracic surgery (RP-VATS) has been developed to minimize surgical invasiveness. Nevertheless, VATS in children can occasionally be difficult because the lesion occupies a small thoracic cavity, limiting the working space. This study aimed to assess the feasibility of RP-VATS for the resection of mediastinal lesions in children in association with the tumor-to-thoracic height ratio (TTH ratio). We reviewed all patients aged ≤10 years who underwent resection for mediastinal lesions in our institute between January 2008 and August 2022. Patients who underwent diagnostic procedures were excluded from this study. The TTH ratio was calculated as tumor height divided by thoracic height. Seven patients in the RP-VATS group and six in the conventional procedures (multi-portal VATS or open surgery) group were included in this study. The TTH ratio was significantly lower in the RP-VATS group than in the conventional procedures group (median, 26.3% 50.8%; P=0.007). The operating time (P=0.01) and duration of drainage (P=0.003) were significantly shorter and the blood loss (P=0.001) was significantly lower in the RP-VATS group than in the conventional procedures group. After adjusting for age, a lower TTH ratio was significantly associated with the completion of RP-VATS (odds ratio: 0.776; 95% confidence interval: 0.529-0.926; P=0.048). In conclusion, RP-VATS can be performed appropriately in carefully selected cases of pediatric mediastinal lesions. A low TTH ratio may predict the feasibility of RP-VATS. Further studies are warranted to determine the criteria for the indications of RP-VATS in children, so that more children can benefit from RP-VATS.
在过去几十年中，为了将手术创伤降至最低，减少切口的电视辅助胸腔镜手术（RP-VATS）得以发展。然而，儿童胸腔镜手术偶尔会很困难，因为病变占据的胸腔较小，限制了操作空间。本研究旨在评估RP-VATS联合肿瘤与胸廓高度比（TTH比）用于儿童纵隔病变切除的可行性。我们回顾了2008年1月至2022年8月期间在我院接受纵隔病变切除术的所有10岁及以下患者。接受诊断性手术的患者被排除在本研究之外。TTH比的计算方法为肿瘤高度除以胸廓高度。本研究纳入了RP-VATS组的7例患者和传统手术（多切口VATS或开放手术）组的6例患者。RP-VATS组的TTH比显著低于传统手术组（中位数分别为26.3%和50.8%；P=0.007）。RP-VATS组的手术时间（P=0.01）和引流时间（P=0.003）显著短于传统手术组，且失血量（P=0.001）显著低于传统手术组。在调整年龄后，较低的TTH比与RP-VATS手术的完成显著相关（比值比：0.776；95%置信区间：0.529-0.926；P=0.04）。总之，在精心挑选的儿童纵隔病变病例中，RP-VATS可以适当开展。低TTH比可能预示RP-VATS的可行性。有必要进一步研究以确定儿童RP-VATS的适应证标准，以便更多儿童能从RP-VATS中获益。
