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胸腔镜手术治疗婴儿先天性肺囊性畸形的可行性及手术时机探讨
引用本文:马丽霜,冯翠竹,张艳霞,张悦,王莹,孙滨,魏延栋. 胸腔镜手术治疗婴儿先天性肺囊性畸形的可行性及手术时机探讨[J]. 临床小儿外科杂志, 2016, 0(2): 126-128. DOI: 10.3969/j.issn.1671-6353.2016.02.007
作者姓名:马丽霜  冯翠竹  张艳霞  张悦  王莹  孙滨  魏延栋
作者单位:首都儿科医学研究所 北京市,100020
摘    要:目的探讨经胸腔镜手术治疗婴幼儿先天性肺囊性畸形的可行性、安全性及手术时机。方法回顾性分析本院2010年1月至2015年5月因先天性肺囊性畸形而采取胸腔镜手术治疗的10例患儿临床资料。分析其产前检查、产后情况、手术过程及手术后恢复情况。结果 10例中,男性4例,女性6例;手术年龄10天至6个月(平均4.6个月)。其中先天性肺囊腺瘤样畸形3例,肺隔离症6例,先天性肺囊腺瘤样畸形合并肺隔离症1例。10例均为产前检查疑肺囊性畸形,产后经胸部CT确诊。7例术前有肺部感染症状,经抗感染治疗后于生后6个月手术治疗,其中2例于生后1个月内手术,2例无症状,于生后3~6个月手术,患儿均治愈,元手术相关并发症,术后恢复顺利。患儿均在胸腔镜下完成手术。其中1例术后反复感染,2例术后并发肺炎,1例术后出现少许胸腔积液,均经治疗后痊愈。其余患儿恢复良好。平均手术时间175 min,术中平均出血约2 mL,术后拔除引流管时间平均为4.5 d,术后住院时间平均为8 d。全部患儿均门诊或电话随访,随访时间3个月至2年,平均1年4个月。均存活,无肺部相关症状,生长发育、活动量均与正常同龄儿无异。结论所有产前诊断怀疑肺囊性畸形的患儿产后均应随访,并定期行CT检查。对于产前诊断的肺囊性畸形患者,在产后3~6个月行胸腔镜手术治疗可取得满意效果。对于有症状的患儿1个月内行胸腔镜手术是安全的。经胸腔镜手术治疗婴幼儿先天性肺囊性畸形患儿,术后恢复快,手术创伤小,临床疗效满意,是安全和可行的。但手术者需具备熟练的微创手术技术及掌握适当的手术技巧。

关 键 词:囊腺瘤样畸形,隔离症,肺,先天性  胸腔镜  治疗  婴儿

Thoracoscopic surgery for infants with congenital cystic malformation and the feasibility and timing of surgery
Abstract:Objetive To study the feasibility of thoracoscope repair of Congenital Cystic Adenomatoid Malformation(CCAM)and Bronchopulmonary Sequestration(BPS)in neonates and infants. Methods The CCAMand BPS cases in our institution between January 2010 and March 2015 were reviewed.Prenatal exami-nation,postnatal presentation,management and patient outcome were analyzed. Results All infants aged 10 days to 6 months(four males and five females),their median age was 4.6 months.Nine infants with CCAM and /or BPS were repaired by thoracoscope,the median operation time was 5.5 months.There were 2 cases of CCAM,6 cases of BPS,and 1 cases of CCAM with BPS.All patients were diagnosed antenatally at a median gestational age of 20 weeks.Seven patients underwent surgical resection before 6 months of age because of re-peated pulmonary infection.There were no surgical-related complications among the 2 patients who underwent surgery within 1 month of age.All patients survived with no limitations of daily activity during follow-up periods of 3 months to 2 years(the median time was 1 year and 4 months).The median operative duration was 175 mi-nutes,the hospital stay was 8 days and the bleeding volume during operation was under 2ml. Conclutions All cases of antenatally suspected CCAM should be followed up postnatally and investigated with computed tomo-graphy scan.Elective surgery in asymptomatic cases,at around 3 to 6 months of age,showed satisfactory effects. And early surgical resection within 1 month of age is safe in symptomatic patients.Thoracoscope surgery for CCAMand BPS is both safe and efficacious.
Keywords:Cystic Adenomatoid Malformation of Lung,Congenital  Thoracoscopes  Therapy  Infant
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