胸腔镜下婴幼儿隔离肺的处理分析

目的总结分析胸腔镜下婴幼儿隔离肺的手术处理,分析手术的可行性以及风险。方法回顾分析本院2014年3月2015年4月收治的68例隔离肺患儿临床资料,所有隔离肺病例均经产前超声诊断,产前评估及出生后增强CT确诊,包括叶外型隔离肺、叶内型隔离肺、膈肌内隔离肺,分析胸腔镜下操作情况。结果本院共80例产前18~30周B超发现胎儿胸部实性或高回声肿块,经2次以上B超确诊为BPS。所有病例均经专业评估,其中5例因合并胎儿水肿,家属主动中止妊娠;75例继续妊娠至出生并全部存活。64例(85%)出生时无症状,11例(15%)出生时有症状。68例于生后早期增强CT检查进一步确诊为隔离肺,于婴幼儿期行手术治疗,平均手术年龄4.2个月;7例出生后无临床症状,家属拒绝CT检查。68例手术病理分型结果:叶内型30例,叶外型38例,其中叶外型中有9例为膈肌内隔离肺,1例腹腔型隔离肺,28例为胸腔内型隔离肺。手术方式:2例叶内型为全胸腔镜微创手术;28例为胸腔镜辅助手术;9例膈肌内隔离肺中,6例采用全胸腔镜微创手术,3例为胸腔镜辅助手术;1例腹腔型隔离肺采用传统开腹手术;胸腔内型隔离肺28例全部采用全胸腔镜微创手术。所有病例均治愈。均获1个月至1年的随访,CT检查生长发育及肺功能均良好。结论婴幼儿隔离肺在先天性肺部发育异常中相对少见。由于存在感染以及对周围肺组织的压迫风险,建议早期手术。胸腔镜下操作,对于婴幼儿隔离肺,相比传统开胸手术,不会增加手术风险,是一种可行的手术方式。

An Analysis on Thoracoscopic Operation for Congenital Bronchopulmonary Sequestrations

Objetive To research and discuss the feasibility and risk of bronchopulmonary sequestra-tions under thoracoscopic operation.Methods Retrospe -ctively reviewed our experience with bronchopulmo-nary sequestrations from 2014.3 to 2015.4.All 68cases were diagnosed by prenatal ultrasound and postnatal contrast -enhanced CT,including Intralobar,extralobar and intradiaphragmatic extralobar pulmonary sequestra-tion.To research and discuss the feasibility and risk under thoracoscopic operation.Results All 80 cases (18-30 w)of fetal chest solid or high echo mass were diagnosed antenatally by ultrasound,been confirmed by later ultrasound examination.5 cases associated with fetal hydrops for abortion.The other 75 cases borned ,with a-symptomatic in 64 cases(85%).Enhanced CT was used to confirm the diagnosis in 68 cases ,and all choosen to operation(Average 4.2 Months).In typing,30 cases of intralobar,extralobar in 38 cases.In extralobar cases, 9 cases within the diaphragm and 1 cases in enterocoelia,28 cases in thorax.operation methods:2 cases by tho-racoscope and 28 cases by video -assisted thoracic surgery in intralobar type;6 cases by thoracoscope and 3 cases by video -assisted thoracic surgery in intradiaphragmatic extralobar type;1 case in enterocoelia by tradi-tional laparotomy;all 28 extralobar cases in thorax by thoracoscope.All patients were cured.All 68 patients been follow -up from 1 month to 1 year,CT examination and lung function examination showed well. Conclu-sions Bronchopulmonary sequestration is relatively uncommon in infants.Due to the risk in infection and com-pressing symptom of surrounding tissue,we suggested to operate early.The thoracoscopic approach is recommen-ded.