单中心连续性胸腔镜治疗小儿肺隔离症30例经验

目的总结胸腔镜治疗小儿肺隔离症的经验。方法回顾性分析我院2018年1~12月连续30例胸腔镜治疗小儿肺隔离症资料,年龄2天~13岁4个月,中位数7.5月。合并膈疝1例、隔离肺感染2例、肺囊肿1例,其余均为单纯性隔离肺。3个月以上患儿原则上行单肺通气,3个月以下患儿双肺通气,术中监测心率(HR)、动脉血压(ABP)、脉搏氧饱和度(SpO2)、呼气末CO2分压(PetCO2)和动脉血气分析。结果全胸腔镜下隔离肺切除25例,1例隔离肺滋养血管和肺血管双重供血,胸腔镜下行滋养血管夹闭,4例中转开胸手术。无支气管胸膜瘘、呼吸衰竭等严重并发症,无手术死亡。术后随访4~15个月,中位数10.2月,均恢复顺利,无反复肺部感染,无咯血。结论胸腔镜治疗小儿肺隔离症安全可行,可根据不同年龄选择不同的麻醉肺通气策略,术中生命体征和呼吸指标的监测至关重要。

Experience of Single Center Continuous Thoracoscopy in Treatment of Pulmonary Sequestration in 30 Children

Objective To summarize the treatment experience of pulmonary sequestration(PS)by thoracoscopy in children.Methods Data of 30 consecutive children(aged 2 days-13 years and 4 months old,median,7.5 months old)from January to December 2018 were retrospectively analyzed.There were 1 case of diaphragmatic hernia,2 cases of isolated lung infection,and 1 case of pulmonary cyst.The remaining cases were simple isolated lung.For children over 3 months,one-lung ventilation and anesthesia was utilized,while for children under 3 months,two-lung ventilation was given.Intraoperative monitoring of heart rate(HR),arterial blood pressure(ABP),pulse oximetry(SpO2),end-tidal carbon dioxide partial pressure(PetCO2)and arterial blood gas analysis were conducted.Results A total of 25 cases underwent total thoracoscopic pneumonectomy,1 case with isolated pulmonary nourishing vessel and pulmonary vessel double blood supply underwent nourishig vessel clipping,and 4 cases converted to traditional thoracotomy.There were no serious postoperative complications such as bronchopleural fistula or respiratory failure.No fatal case was found.After 4-15 months(median 10.2 months)of follow-ups,all the children recovered smoothly,and no recurrent pulmonary infection or hemoptysis occurred.Conclusion Thoracoscopic treatment of pulmonary sequestration in children is safe and feasible,and different strategies of anesthetic pulmonary ventilation should be selected according to different ages.