[1]赵华善翟允鹏郭锐白月霞①许洪修黄赛沈刚张士松**.胸腔镜手术治疗小儿先天性肺气道畸形或肺隔离症合并同侧纵隔支气管源性囊肿7例[J].中国微创外科杂志,2025,01(2):92-96.
　Zhao Huashan,Zhai Yunpeng,Guo Rui,et al.Videoassisted Thoracoscopic Surgery in the Treatment of 7 Children With Pulmonary Airway Malformation or Pulmonary Isolation Complicated With Ipsilateral Mediastinal Bronchogenic Cysts[J].Chinese Journal of Minimally Invasive Surgery,2025,01(2):92-96.
点击复制

胸腔镜手术治疗小儿先天性肺气道畸形或肺隔离症合并同侧纵隔支气管源性囊肿7例()
分享到：

《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2025年2期
页码:
92-96
栏目:
短篇论著
出版日期:
2025-02-25

文章信息/Info

Title:
Videoassisted Thoracoscopic Surgery in the Treatment of 7 Children With Pulmonary Airway Malformation or Pulmonary Isolation Complicated With Ipsilateral Mediastinal Bronchogenic Cysts
作者:
赵华善翟允鹏郭锐白月霞①许洪修黄赛沈刚张士松**
(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):
Zhao Huashan;  Zhai Yunpeng;  Guo Rui;  et al.
Department of Surgery of Thoracic Oncology, Children’s Hospital Affiliated to Shandong University, Jinan Children’s Hospital, Jinan 250022, China
关键词:
胸腔镜手术; 小儿; 先天性肺气道畸形; 肺隔离症; 支气管源性囊肿
Keywords:
Videoassisted thoracoscopic surgery; Children; Congenital pulmonary airway malformation; Pulmonary isolation; Bronchogenic cysts
文献标志码:
A
摘要:
目的探讨胸腔镜手术治疗小儿先天性肺气道畸形(congenital pulmonary airway malformation，CPAM)或肺隔离症合并同侧纵隔支气管源性囊肿的可行性。方法2019年7月~2024年7月我们采用胸腔镜手术治疗CPAM或肺隔离症合并支气管源性囊肿7例。侧胸入路三孔法全胸腔镜手术，患儿健侧卧位，观察孔为肩胛下线与第5肋间交点处，操作孔根据手术需要结合腔镜菱形法建立，三孔均使用5 mm trocar。CO2气胸压力4 mm Hg，流量2 L/min，根据患儿术中情况随时调整。手术切口以肺手术为主进行设计，先进行肺部手术，再切除支气管源性囊肿，必要时分块切除以避免气管的严重并发症。结果7例手术均在胸腔镜下完成，无中转开放手术。手术时间37~191 min(中位时间101 min)。术中出血量1~15 ml(中位数5 ml)。1例未留置胸腔闭式引流管，6例留置胸腔闭式引流管留置1~5 d(中位数3 d)。术后病理：CPAM合并支气管源性囊肿5例，其中2型(细支气管型)4例，3型(细支气管/肺泡型)1例，叶外型肺隔离症合并支气管源性囊肿2例。7例随访6~57个月(中位数27个月)，胸部CT示均无病变复发。结论小儿CPAM或肺隔离症可能同时合并支气管源性囊肿，术前影像学检查与手术观察相对应，仔细探查，避免漏诊。胸腔镜手术治疗小儿CPAM或肺隔离症合并同侧纵隔支气管源性囊肿安全可行。
Abstract:
ObjectiveTo explore the feasibility of videoassisted thoracoscopic surgery (VATS) in the treatment of congenital pulmonary airway malformation (CPAM) or pulmonary isolation complicated with ipsilateral mediastinal bronchogenic cyst in children.MethodsFrom July 2019 to July 2024, VATS was carried out to treat CPAM or pulmonary isolation with ipsilateral mediastinal bronchogenic cyst in 7 children. A threehole thoracoscopic surgery via lateral thoracic approach was performed. The patients were placed in a healthy lateral position. The observation hole was located at the intersection of the subscapular line and the 5th intercostal space, and the operating hole was established according to the surgical requirements in combination with the lumboscopic diamond rule. A 5 mm trocar was used for all three holes. The pressure of CO2 pneumothorax was 4 mm Hg and the flow rate was 2 L/min, which was adjusted at any time according to the intraoperative conditions of the children. The operation was mainly designed for lung operation. The pulmonary operation was conducted firstly, and then the bronchogenic cyst was treated. If necessary, block resection was applied to avoid serious complications of trachea.ResultsAll the operations were performed under thoracoscopy without conversion to open surgery. The operation time was 37-191 min (median, 101 min). The intraoperative bleeding volume was 1-15 ml (median, 5 ml). One case was not given a closed chest drainage tube placed, and the other 6 cases were placed a closed chest drainage for 1-5 d (median, 3 d). Postoperative pathology showed 5 cases of CPAM combined with bronchogenic cysts, including 4 cases of type 2 (bronchiole type) and 1 case of type 3 (bronchiole/alveolar type), and 2 cases of extralobular pulmonary isolation combined with bronchogenic cysts. All the 7 cases were followed up for 6-57 months (median, 27 months), and chest CT showed no recurrence of lesions.ConclusionsCPAM or pulmonary isolation may be accompanied by bronchogenic cysts. Preoperative imaging examination should correspond to surgical observation, and careful exploration should be conducted to avoid missed diagnosis. VATS is safe and feasible for treating CPAM or pulmonary isolation with ipsilateral mediastinal bronchogenic cysts.

参考文献/References:

[1] 中华医学会小儿外科学分会普胸外科学组, 中国医疗保健国际交流促进会妇儿医疗保健分会. 先天性肺气道畸形诊疗中国专家共识(2021版). 中华小儿外科杂志, 2021, 42(8):679-687.
[2] Zhao H, Zhai Y, Guo R, et al. Simultaneous occurrence of extralobar pulmonary sequestration, esophageal duplication, and bronchogenic cysts in a Chinese child: a rare case report. Front Pediatr, 2024, 12:1367626.
[3] 赵华善, 翟允鹏, 郭锐, 等. 胸腔镜手术治疗婴儿先天性肺气道畸形合并完全性心包缺如1例报告. 中国微创外科杂志, 2022, 22(8):682-684.
[4] 王链链, 唐慧荣, 王娅, 等. 不同胎儿先天性肺气道畸形容积比病例的临床特点及孕期母体糖皮质激素治疗效果. 中华围产医学杂志, 2024, 27(8):624-630.
[5] 彭思琪, 杨澜, 黄茂, 等. 先天性肺气道畸形的诊治现状和问题. 国际呼吸杂志, 2024, 44(1):92-97.
[6] 郭锐, 翟允鹏, 张士松, 等. 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. 中国微创外科杂志, 2022, 22(9):757-762.
[7] Guo R, Liu J, Zhai Y, et al. Initial experience of thoracoscopic segmentectomy of basal segment through the inferior pulmonary ligament approach in treating congenital lung malformations in children. BMC Pediatr, 2023, 23(1):460.
[8] 罗登科, 王清海, 程凯昇, 等. 胸腔镜钟向式肺叶切除术治疗儿童先天性肺畸形的临床研究. 中华小儿外科杂志, 2022, 43(9):801-805.
[9] Liu C, Cheng K, He T, et al. Ten-year experience in the clinical management of intralobar pulmonary sequestration in children. Pediatr Pulmonol, 2023, 58(4):1022-1027.
[10] 吕龙飞, 李继如, 翟允鹏, 等. 单术者双孔法在电视辅助胸腔镜手术治疗儿童叶外型肺隔离症中的早期临床应用. 山东大学学报(医学版), 2024, 62(1):57-62.
[11] 肖鑫华, 黄宏. 81例肺隔离症患者的临床特征与不同治疗方法的网状Meta分析. 华中科技大学学报(医学版), 2024, 53(4):519-527.
[12] 赵华善, 翟允鹏, 郭锐, 等. 胸腔镜手术治疗小儿纵隔前肠源性囊肿27例. 中国微创外科杂志, 2024, 24(6):427-431.
[13] 许世广, 王希龙, 童向东, 等. 机器人与电视胸腔镜手术治疗纵隔支气管源性囊肿的对比研究. 中国微创外科杂志, 2015, 15(3):193-196.
[14] 陈伟, 徐梦柔, 王庆煜, 等. 儿童颈部支气管源性囊肿诊治分析. 临床耳鼻咽喉头颈外科杂志, 2023, 37(11):916-919.
[15] 王敏, 赵滨, 王春祥. 纵隔内叶外型肺隔离症合并支气管源性囊肿1例. 中国医学影像学杂志, 2021, 29(7):689-690.
[16] 张书新, 赵亚超, 周爱国, 等. 同期双侧胸腔镜手术在双肺多发肺结节外科治疗中的应用价值. 南方医科大学学报, 2023, 43(7):1254-1258.
[17] 徐广文, 解明然, 王高祥, 等. 同期双侧单孔胸腔镜手术在双肺多发结节治疗中的应用. 中山大学学报(医学科学版), 2022, 43(6):1012-1019.
[18] 汪凤华, 梁建华, 李乐, 等. 18例先天性膈疝合并肺隔离症的诊治. 中华胸心血管外科杂志, 2020, 36(12):763-764.
[19] Lin S, Yang C, Guo X, et al. Simultaneous uniportal video-assisted thoracic surgery of bilateral pulmonary nodules. J Cardiothorac Surg, 2021, 16(1):42.
[20] Yao F, Yang H, Zhao H. Single-stage bilateral pulmonary resections by video-assisted thoracic surgery for multiple small nodules. J Thorac Dis, 2016, 8(3):469-475.（收稿日期：2024-09-０7）

备注/Memo

备注/Memo:
基金项目：2024年济南市卫生健康委员会科技发展计划项目（2024304040）**通讯作者，Email：zsli323@163.com①病理科
更新日期/Last Update: 2025-04-29