[1]郭锐 翟允鹏 张士松** 赵华善 许洪修 吕龙飞.胸腔镜下后基底段解剖性病灶切除治疗小儿先天性肺气道畸形[J].中国微创外科杂志,2022,01(9):757-762.
　Guo Rui,Zhai Yunpeng,Zhang Shisong,et al.Thoracoscopic Anatomical Lesion Resection of Posterior Basal Segment for Congenital Pulmonary Airway Malformation in Children[J].Chinese Journal of Minimally Invasive Surgery,2022,01(9):757-762.
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胸腔镜下后基底段解剖性病灶切除治疗小儿先天性肺气道畸形()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2022年9期
页码:
757-762
栏目:
经验交流
出版日期:
2023-01-13

文章信息/Info

Title:
Thoracoscopic Anatomical Lesion Resection of Posterior Basal Segment for Congenital Pulmonary Airway Malformation in Children
作者:
郭锐 翟允鹏 张士松** 赵华善 许洪修 吕龙飞
(山东大学附属儿童医院济南市儿童医院胸外肿瘤外科，济南250022)
Author(s):
Guo Rui;  Zhai Yunpeng;  Zhang Shisong;  et al.
Department of Thoracic and Tumor Surgery, Jinan Children’s Hospital, Children’s Hospital of Shandong University, Jinan 250022,China
关键词:
胸腔镜; 先天性肺气道畸形; 解剖性病灶切除
Keywords:
Thoracoscopy; Congenital pulmonary airway malformation; Anatomical lesion resection
文献标志码:
B
摘要:
目的探讨胸腔镜下后基底段(S10)解剖性病灶切除治疗小儿先天性肺气道畸形(congenital pulmonary airway malformation，CPAM)的可行性。方法2021年2月~2022年2月我科对14例小儿CPAM行胸腔镜S10解剖性病灶切除，电钩标记出病灶的外在边界，解剖并保留病灶与正常肺组织之间的段间静脉或亚段间静脉作为内在边界，切断进入病灶的动静脉及支气管，LigaSure切开并封闭内外边界之间的肺组织完成解剖性病灶切除。结果14例均在胸腔镜下完成手术，无中转开胸。右侧解剖性病灶切除10例，左侧解剖性病灶切除3例；1例拟行右侧解剖性病灶切除，因病变肺组织炎症反应较重，血管及支气管结构不清晰，内在边界确定困难，沿病变边缘行扩大不规则切除。手术时间50~170 min，中位数71 min；术中出血量5~30 ml，中位数5 ml。13例术后留置引流管2~4 d，中位数3 d；漏气1例，引流9 d。术后住院时间4~12 d，中位数6 d。病理诊断：1型3例，2型9例，3型2例。术后漏气1例，考虑创面漏气，调整引流管位置并延长留置引流管时间后漏气消失；单纯皮下气肿2 例，保守观察后皮下气肿消失；无出血、支气管胸膜瘘、肺不张等并发症。14例随访1~12个月，中位数8个月，复查胸部CT均未见残余病灶，患侧胸腔无残腔。结论对于病灶位于S10外周的小儿CPAM，胸腔镜下经下肺韧带入路进行解剖性病灶切除是安全、可行的。
Abstract:
ObjectiveTo investigate the feasibility of thoracoscopic anatomical lesion resection of posterior basal segment (S10) in the treatment of congenital pulmonary airway malformation (CPAM).MethodsClinical data of 14 children with CPAM who underwent thoracoscopic anatomical lesion resection of S10 from February 2021 to February 2022 were analyzed retrospectively. We marked the external boundary of the lesion with an electric hook, dissected and retained the segmental vein or the subsegmental vein between the lesion and normal lung tissue as the internal boundary, cut off 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 anatomical lesion resection.ResultsAll the operations were completed under thoracoscopy without conversion to thoracotomy. Right anatomical lesion resection was performed in 10 cases and left anatomical lesion resection in 3 cases. In one case, the right anatomical lesion was planned to be resected, but due to the severe inflammatory reaction of the lung tissue, unclear vascular and bronchial structures, and difficulty in determining the internal boundary, the enlarged irregular resection was performed along the edge of the lesion. The operation time was 50-170 min, with a median of 71 min. The intraoperative bleeding was 5-30 ml, with a median of 5 ml. There were 13 cases with indwelling drainage tube for 2-4 d, with a median of 3 d. One case had air leakage and drainage for 9 d. The postoperative hospital stay was 4-12 d, with a median of 6 d. Pathological diagnosis included 3 cases of type 1, 9 cases of type 2, and 2 cases of type 3. Air leakage occurred in 1 case after operation. The air leakage disappeared after adjusting the position of drainage tube and prolonging the indwelling time of drainage tube. There were 2 cases of simple subcutaneous emphysema after operation. The subcutaneous emphysema disappeared after conservative observation. There were no complications such as bleeding, bronchopleural fistula or atelectasis. The patients were followed up for 1-12 months, with a median of 8 months. No residual lesions were found in the chest CT, and there was no residual cavity in the affected side of the chest.ConclusionIt is safe and feasible to perform anatomical lesion resection through the lower pulmonary ligament approach under thoracoscopy for children with CPAM located around S10.

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备注/Memo

备注/Memo:
基金项目：2022年度济南市卫生健康委员会科技计划项目（2022-1-49）**通讯作者，Email:zsli323@163.com
更新日期/Last Update: 2023-01-13