López-Diaz María, Cano Novillo Indalecio, Morante-Valverde Rocío, García Vázquez Araceli, Romero Layos Manuel, Galindo Izquierdo Alberto, Antón-Pacheco Juan L
Pediatric Airway Unit & Division of Pediatric Surgery, University Hospital 12 de Octubre, Madrid, Spain.
Division of Pediatric Surgery, University Hospital 12 de Octubre, Madrid, Spain.
J Pediatr Surg. 2025 Jan;60(1):161992. doi: 10.1016/j.jpedsurg.2024.161992. Epub 2024 Oct 9.
The aim of this study was to determine the incidence of complications after thoracoscopic lobectomy in children according to a verified classification. Secondary aim was to evaluate the modifications made in our management protocol in order to decrease the rate of complications.
Retrospective study of pediatric patients in whom a lobectomy was performed for congenital lung malformation (CLM) in our institution between 2003 and 2021. The following data were collected: demographics, preoperative clinical symptoms, surgical technical details, and postoperative complications following the Clavien-Dindo (CD) classification. Main outcome measure was the presence of complications in the first month after lung lobectomy.
90 lobectomies were performed in 89 patients. There were 46 girls (51.6%) and 43 boys with a median age of 12.4 months. Most patients (86.6%) remained asymptomatic until the surgical procedure. Postsurgical complications were detected in 26 cases (28.8%) and distributed into their respective category according to CD classification. In our experience, closure of the bronchial stump with interrupted suture or placement of an endoloop showed a statistically significant association with complications (p = 0.022 and p = 0.006 respectively). Moreover, patients in which a device combining sealing and section was used showed significantly fewer complications (p = 0.006).
Thoracoscopic lobectomy continues to be a challenging procedure. The CD grading system for postoperative complications has proved to be useful in this setting. Evolving surgical strategies and new miniaturized endosurgical devices have enabled a safer and quicker procedure with a positive impact in the development of complications.
III.
本研究的目的是根据经过验证的分类方法确定儿童胸腔镜肺叶切除术后并发症的发生率。次要目的是评估我们管理方案中为降低并发症发生率而做出的调整。
对2003年至2021年期间在我们机构因先天性肺畸形（CLM）接受肺叶切除术的儿科患者进行回顾性研究。收集了以下数据：人口统计学资料、术前临床症状、手术技术细节以及根据Clavien-Dindo（CD）分类的术后并发症。主要观察指标是肺叶切除术后第一个月内并发症的发生情况。
89例患者共进行了90次肺叶切除术。其中有46名女孩（51.6%）和43名男孩，中位年龄为12.4个月。大多数患者（86.6%）在手术前无症状。术后26例（28.8%）出现并发症，并根据CD分类归入各自类别。根据我们的经验，间断缝合关闭支气管残端或放置内套环与并发症有统计学显著关联（分别为p = 0.022和p = 0.006）。此外，使用密封和切割组合装置的患者并发症明显较少（p = 0.006）。
胸腔镜肺叶切除术仍然是一项具有挑战性的手术。术后并发症的CD分级系统在这种情况下已被证明是有用的。不断发展的手术策略和新型小型化内镜手术器械使手术更安全、更快捷，对并发症的发生有积极影响。
III级
