[1]郭锐 翟允鹏 赵华善 许洪修 吕龙飞 张士松*.胸腔镜复杂肺段切除（S10、S9+10）治疗先天性肺气道畸形[J].中国微创外科杂志,2021,01(12):1077-1082.
　Guo Rui,Zhai Yunpeng,Zhao Huashan,et al.Preliminary Experience of Thoracoscopic Complex Segmental Resection (S10 or S9+10) in the Treatment of Congenital Pulmonary Airway Malformation[J].Chinese Journal of Minimally Invasive Surgery,2021,01(12):1077-1082.
点击复制

胸腔镜复杂肺段切除（S10、S9+10）治疗先天性肺气道畸形()
分享到：

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

卷:
01
期数:
2021年12期
页码:
1077-1082
栏目:
临床研究
出版日期:
2021-12-25

文章信息/Info

Title:
Preliminary Experience of Thoracoscopic Complex Segmental Resection (S10 or S9+10) in the Treatment of Congenital Pulmonary Airway Malformation
作者:
郭锐 翟允鹏 赵华善 许洪修 吕龙飞 张士松*
（山东大学齐鲁儿童医院胸外肿瘤外科，济南250022）
Author(s):
Guo Rui;  Zhai Yunpeng;  Zhao Huashan;  et al.
Department of Thoracic and Tumor Surgery, Qilu Children’s Hospital of Shandong University, Jinan 250022, China
关键词:
胸腔镜; 先天性肺气道畸形; 肺段切除
Keywords:
Thoracoscopy; Congenital pulmonary airway malformation; Segmentectomy
文献标志码:
A
摘要:
目的探讨胸腔镜复杂肺段切除（S10、S9+10）治疗先天性肺气道畸形（congenital pulmonary airway malformation，CPAM）的可行性。方法回顾性分析2019年1月~2021年4月21例CPAM行胸腔镜S10或S9+10切除的临床资料，年龄35~11.5月（中位数6.4月），体重6.5~11.5 kg（中位数9.0 kg）。改良“膨胀萎陷法”确定段间平面。结果手术均在胸腔镜下完成，无中转开胸。右S10切除4例，右S9+10切除8例；左S10切除5例，左S9+10切除3例。1例拟行右S9+10切除，因误断基底段支气管，改为右基底段切除。手术时间78~205 min，中位数114 min；术中出血5~15 ml。20例术后留置引流管2~5 d，中位数3 d；漏气1例，引流13 d。术后住院时间4~15 d，中位数6 d。病理诊断1型6例，2型12例，3型3例。皮下气肿2例，包裹性气胸1例，无出血、支气管胸膜瘘、肺不张等并发症。随访1~27个月，中位数10个月，复查胸部CT均未见残余病灶，患侧胸腔无残腔。结论胸腔镜复杂肺段切除（S10、S9+10）相对安全、可行。
Abstract:
ObjectiveTo investigate the feasibility of thoracoscopic complex segmental resection (S10 or S9+10) in the treatment of congenital pulmonary airway malformation (CPAM). MethodsClinical data of 21 infants with CPAM who underwent thoracoscopic S10 or S9+10 resection from January 2019 to April 2021 were collected. The age ranged from 3.5 to 11.5 months old (median, 6.4 months old) and the weight ranged from 6.5 to 11.5 kg (median, 9.0 kg). The intersegment plane was determined by improved “expansion collapse method”. ResultsAll the operations were performed under thoracoscopy, and there was no conversion to thoracotomy. Among them, right S10 was resected in 4 cases, right S9+10 in 8 cases, left S10 in 5 cases and left S9+10 in 3 cases. One case was planned to undergo right S9+10 resection, while because the basal segment bronchus was broken by mistake, it was changed to right basal segment resection. The operation time ranged 78-205 min, with a median of 114 min. The intraoperative blood loss ranged 5-15 ml. A total of 20 cases were given indwelling drainage for 2-5 d, with a median of 3 d. One case had air leakage and was drained for 13 d. Postoperative hospital stay ranged 4-15 d, with a median of 6 d. Postoperative pathological examinations showed that there were 6 cases of type 1, 12 cases of type 2 and 3 cases of type 3. There were 2 cases of subcutaneous emphysema and 1 case of encapsulated pneumothorax. There were no complications such as bleeding, bronchopleural fistula or atelectasis. The patients were followed up for 1-27 months, with a median of 10 months. No residual lesions were found in the chest CT, and there was no residual cavity in the affected side of the chest. Conclusion Thoracoscopic resection of complex lung segments (S10 or S9+10) is relatively safe and feasible.

参考文献/References:

[1]Gornall AS,Budd JL,Draper ES,et al.Congenital cystic adenomatoid malformation:accuracy of prenatal diagnosis,prevalence and outcome in a general population.Prenat Diagn,2003,23(12):997-1002.
[2]Stanton M,Njere I,AdeAjayi N,et al.Systematic review and metaanalysis of the postnatal management of congenital cystic lung lesions.J Pediatr Surg,2009,44(5):1027-1033.
[3]Downard CD,Calkins CM,Williams RF,et al.Treatment of congenital pulmonary airway malformations: a systematic review from the APSA outcomes and evidence based practice committee.Pediatr Surg Int,2017,33(9):939-953.
[4]于洁,张娜,陈诚豪,等.先天性肺气道畸形的诊断和治疗.中华胸心血管外科杂志,2018,34(8):469-472.
[5]Wong KKY,Flake AW,Tibboel D,et al.Congenital pulmonary airway malformation:advances and controversies.Lancet Child Adolesc Health,2018,2(4):290-297.
[6]Rothenberg SS,Shipman K,Kay S,et al.Thoracoscopic segmentectomy for congenital and acquired pulmonary disease:a case for lungsparing surgery.J Laparoendosc Adv Surg Tech A,2014,24(1):50-54.
[7]Peranteau WH,Merchant AM,Hedrick HL,et al.Prenatal course and postnatal management of peripheral bronchial atresia:association with congenital cystic adenomatoid malformation of the lung.Fetal Diagn Ther,2008,24(3):190-196.
[8]Johnson SM,Grace N,Edwards MJ,et al.Thoracoscopic segmentectomy for treatment of congenital lung malformations.J Pediatr Surg,2011,46(12):2265-2269.
[9]Rothenberg SS,Shipman K,Kay S,et al.Thoracoscopic segmentectomy for congenital and acquired pulmonary disease:a case for lungsparing surgery.J Laparoendosc Adv Surg Tech A,2014,24(1):50-54.
[10]FascettiLeon F,Gobbi D,Pavia SV,et al.Sparinglung surgery for the treatment of congenital lung malformations.J Pediatr Surg,2013,48(7):1476-1480.
[11]Nakazawa S,Shimizu K,Mogi A,et al.VATS segmentectomy: past,present,and future.Gen Thorac Cardiovasc Surg,2018,66(2):81-90.
[12]Igai H,Kamiyoshihara M,Yoshikawa R,et al.The safety and feasibility of thoracoscopic uncommon pulmonary segmentectomy.J Thorac Dis,2019,11(7):2788-2794.
[13]Karenovics W,Gonzalez M.How to decrease technical obstacles to difficult videoassisted thoracoscopic surgery segmentectomy?J Thorac Dis,2019,11(1):53-56.
[14]Sato M,Murayama T,Nakajima J.Thoracoscopic staplerbased “bidirectional” segmentectomy for posterior basal segment (S10) and its variants.J Thorac Dis,2018,10(Suppl 10):S1179-S1186.
[15]梁志刚,蒋连勇,谢晓,等.经下肺韧带方向胸腔镜单向式肺后外基底段切除的应用.中国胸心血管外科临床杂志,2019,26(12):1176-1179.
[16]王元详,提运幸,黄骏荣,等.全胸腔镜解剖性肺段切除术治疗儿童先天性肺气道畸形的经验体会.中华小儿外科杂志,2021,42(4):299-303.
[17]李乐,曾嘉航,梁建华,等.三维重建联合吲哚菁绿荧光导航在儿童肺段切除术中的应用.中华小儿外科杂志,2021,42(4):310-314.
[18]程凯昇,袁淼,徐畅,等.胸腔镜解剖性肺段切除治疗j54d’;000009999990i 童先天性肺疾病临床分析.四川大学学报（医学版）,2019,50(4):594-597.

备注/Memo

备注/Memo:
*通讯作者，Email：zsli323@163.com
更新日期/Last Update: 2022-04-07