Zhu Tianqi, Li Yanan, Zhang Jiaxin, Xiong Xiaofeng, Yin Ye, Zhuansun Didi, He Ying, Feng Jiexiong
Department of Pediatric Surgery, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China.
Department of Pediatric Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China.
J Pediatr Surg. 2025 Jan;60(1):162063. doi: 10.1016/j.jpedsurg.2024.162063. Epub 2024 Nov 12.
Lobectomy resection is the standard treatment for patients with congenital pulmonary airway malformation (CPAM). However, accurate localization of CPAM lesions and avoiding excessive resection of normal lung tissue are one of the critical issues that can impact postoperative pulmonary function. Indocyanine green (ICG) can be adopted in lung preservation surgery, to minimize damage to normal lung tissue during thoracoscopic pneumonectomy.
To demonstrate the potential benefits of aerosol inhalation of ICG followed by thoracoscopic precision pneumonectomy for the treatment of CPAM.
From January 2023 to March 2024, we prospectively collected clinical data from 34 pediatric patients diagnosed with CPAM and treated with thoracoscopic surgery. Patients inhaled ICG aerosol solution (0.5 mg/kg) approximately 30-60 min before the operation. During surgery, fluorescence thoracoscopy was used to clearly locate the lesion boundaries and achieve precise resection.
All patients successfully underwent thoracoscopic precise resection of CPAM lesions without conversion to open surgery. The mean operation time was 100.3 ± 24.6 min, and the mean intraoperative blood loss was 30.5 ± 25.6 mL. The mean total length of hospital stay (tLOS) was 6.6 ± 3.2 days. No adverse reactions to ICG were observed. Postoperative complications included one case of pneumothorax (5.9 %) and three cases of subcutaneous emphysema (17.6 %), all of which resolved without special intervention. Follow-up CT scans and pulmonary function tests conducted 6 months post-surgery demonstrated the absence of residual or recurrent lesions and notable enhancement in pulmonary function.
Preliminary results indicated that the treatment of CPAM with aerosolized ICG followed by thoracoscopic precise pneumonectomy is safe and feasible.
肺叶切除术是先天性肺气道畸形（CPAM）患者的标准治疗方法。然而，CPAM病变的准确定位以及避免过度切除正常肺组织是影响术后肺功能的关键问题之一。吲哚菁绿（ICG）可用于肺保留手术，以在胸腔镜肺切除术中尽量减少对正常肺组织的损伤。
证明雾化吸入ICG后行胸腔镜精准肺切除术治疗CPAM的潜在益处。
2023年1月至2024年3月，我们前瞻性收集了34例诊断为CPAM并接受胸腔镜手术治疗的儿科患者的临床资料。患者在手术前约30 - 60分钟吸入ICG雾化溶液（0.5mg/kg）。手术过程中，使用荧光胸腔镜清晰定位病变边界并实现精准切除。
所有患者均成功接受胸腔镜下CPAM病变的精准切除，无需转为开放手术。平均手术时间为100.3±24.6分钟，平均术中出血量为30.5±25.6毫升。平均总住院时间（tLOS）为6.6±3.2天。未观察到对ICG的不良反应。术后并发症包括1例气胸（5.9%）和3例皮下气肿（17.6%），均无需特殊干预即自行缓解。术后6个月进行的随访CT扫描和肺功能测试显示无残留或复发病变，肺功能有显著改善。
初步结果表明雾化ICG后行胸腔镜精准肺切除术治疗CPAM是安全可行的。
