Minimally Invasive Surgery in Pediatric Cancer Patients

Background: The specific use of minimally invasive surgery (MIS) in pediatric cancer patients is limited. We evaluated the 5-year experience at a single institution with MIS in children with malignancies.Methods: A retrospective review was undertaken of all MIS performed between November 1995 and October 2010434_2004_Article_340.Results: A total of 101 pediatric oncology patients underwent 113 MIS procedures—64 laparoscopic (57%) and 49 thoracoscopic (43%)—during this period. Laparoscopy was performed for diagnostic purposes in 27 cases (42%) and was successful in 25 (93%) cases. Laparoscopic tumor resection was performed in seven cases (11%). Thirty additional laparoscopic procedures (47%) were attempted for complications of the malignancy or its treatment. Four of these cases were converted to open laparotomies. Indications for thoracoscopy included the evaluation of a mediastinal mass (n = 7) or biopsy or resection of pulmonary lesions (metastatic, n = 31; infectious, n = 9). Fourteen cases (29%) had to be converted to open thoracotomy procedures, generally because of the inability to localize a lesion. The other 35 procedures were successful. The overall complication rate was 5%. No trocar site recurrences or infections were observed.Conclusions: We conclude that MIS in pediatric cancer patients is a safe and effective diagnostic modality. The role of MIS for primary tumor resection remains to be defined.     

Thoracoscopic treatment of spontaneous pneumothorax in children

Background/purpose

This study describes the authors experience and results with thoracoscopic treatment of spontaneous pneumotrorax (SP) in 22 children.

Methods

A total of 32 thoracoscopic procedures were performed in 22 children. The patients ranged in age from 9 to 21 years at the time of their first thoracoscopy. SP was primary in 9 and secondary in 13 patients. Pleurodesis was performed in all thoracoscopies using talc in 28 and pleural abrasion in 4 procedures. In 2 of these, apical pleurectomy was added to abrasion. Blebectomy was the additional surgical procedure associated with pleurodesis in 4 patients.

Results

Thoracoscopy usually was performed with the patient under general anesthesia. In children with severe respiratory insufficiency, regional anesthesia was used. The mean operative time was 42.6 minutes (range, 8 to 114 minutes). The mean time of postoperative chest tube drainage was 4.6 days (range, 2 to 12 days). Three patients with cystic fibrosis had prolonged air leak lasting longer than 7 days after thoracoscopy. None of them required an additional surgical intervention, and the air leak ceased in 8, 8, and 12 days with continuous suction. One patient required a repeat thoracoscopy for bleeding from an intercostal artery on postoperative day one. The mean follow-up was 4 years (range, 2.5 months to 14 years). There have been 2 partial recurrences (6.25%), both in patients with secondary SP, which were treated by a repeat thoracoscopy and talc pleurodesis.

Conclusions

Thoracoscopic treatment of SP is safe and effective in children. It can be performed under regional anesthesia also in children with severe respiratory insufficiency. Because the complications and recurrences are encountered more frequently in children with an underlying lung disease, special care in surgical manipulation is required in this subgroup of patients with SP.     

电视胸腔镜手术治疗胸腺疾病

目的:探讨电视胸腔镜手术治疗胸腺疾病的手术方法和疗效.方法:自1998年4月～2005年10月应用胸腔镜手术治疗胸腺瘤和胸腺伴随综合征(重症肌无力或单纯红细胞再生障碍性贫血)16例.结果:所有手术均在胸腔镜下完成,无中转开胸者.手术时间平均为132 min,术中平均出血量50 mL,术后平均放置胸管时间48 h,平均住院时间6 d,平均随诊3.2年,无肿瘤复发.结论:胸腔镜治疗1期胸腺瘤和重症肌无力具有创伤小、恢复快等显著优势,短期随诊疗效满意.     

胸腔镜在恶性胸腔积液诊断和治疗上的应用

目的　探讨胸腔镜在恶性胸腔积液诊断和治疗上的价值。方法　对15例原因不明的胸腔积液患者作胸腔镜检查,并经胸腔镜喷入滑石粉及顺铂治疗。结果　所有病例经胸腔镜行活检均确诊为恶性病变,总诊断率为100%。经滑石粉喷入和顺铂局部治疗后14例获得完全的胸膜固定,持久的成功率为93.3%。结论　胸腔镜对胸腔积液病因诊断有较高临床实用价值,滑石粉胸膜固定加顺铂治疗是控制恶性胸腔积液、治疗晚期癌症的一种有效方法。     

Chronic sequels after thoracoscopic procedures for benign diseases

Objective: Chronic pains after lateral thoracotomy are present in up to 40% of cases. Chronic sequels after thoracoscopy are less common, but nevertheless, a cause for complaints by patients. Pain often reflects a recurrence of malign disease. For this reason, we only investigated patients with benign disease. Methods: We retrospectively investigated the incidence of chronic sequels in a consecutive series of 161 patients who underwent thoracoscopy for benign disease and were not converted to an open procedure. The data from all 144 patients, contactable at the time of investigation, who were at least 2 months postsurgery, were analyzed. Results: Chronic sequels were present in an overall of 31.4% of patients. Patients complained of chronic pain (20.1%), numbness distal to the incision sites (16.9%) and disaesthesia (8.3%). Painkillers are taken on a regular basis by 82.8% of patients with chronic pain. The use of Staplers, as well as the number of drains (1 vs. 2) used, were statistically significant (P>0.05) for chronic sequels. All other investigated factors, such as sex, age, and length of drainage, were not significantly different in the two groups. Conclusion: The thoracoscopic approach is not likely to impact on the prevalence of long-term postthoracotomy sequels, and therefore, further strengths are necessary to reduce this number.     

胸腔镜胸膜剥除术加综合性治疗恶性胸水的疗效分析

目的：探讨胸腔镜胸膜剥除术加综合性治疗恶性胸水的临床疗效。方法：应用电视胸腔镜技术施行21例恶性胸水的胸膜剥除术，术中用顺铂20mg加注射用水200ml冲洗胸腔，术后再辅以局部2－3周期和全身4个周期化疗的综合性治疗21例肺内、外肿瘤并恶性胸水病人。治疗完成后，参考WHO近期疗效评价标准和生存质量KPS评分标准进行评价。结果：随访率100％，胸水完全缓解率为90．5％，有效率100％。自觉症状均得到明显改善，治疗后KPS评分较治疗前均提高20分以上，有显著性差异，P＜0．05。生存期超过6个月以上20例。结论：胸腔镜胸膜剥除术辅以术后的局部和全身化疗的综合性治疗模式可有效地提高恶性胸水病人的生活质量和延长生存时间。     

胸腔镜交感神经切除术9例报告

目的 :总结手汗症胸腔镜交感神经切除术的治疗经验。方法 :回顾分析胸腔镜治疗 9例手汗症的临床资料。结果 :9例手术均获成功 ,无中转开胸。 1例躯体出汗增加 ,无 1例手汗症复发。结论 :胸腔镜交感神经切除术治疗手汗症 ,疗效确切 ,是一种安全的手术方法。     

胸腔镜辅助小切口解剖肺叶及全肺切除术的临床研究

目的探讨胸腔镜辅助小切口行解剖肺叶及全肺切除的可行性。方法全麻下应用胸腔镜辅助6~8cm的小切口,用胸腔镜器械及常规开胸器械在电视监视下及辅助小切口直视下进行解剖肺叶或全肺切除。治疗肺癌33例,肺良性病变9例。行肺叶切除39例,全肺切除3例。结果手术时间1.5~4.5h,平均2.5h。术中出血量100~500ml,平均200ml。1例因肿瘤与奇静脉弓紧密粘连而延长切口至12cm,1例左上肺癌因术中癌肿与肺动脉粘连较紧,分离时致肺动脉干血管损伤出血而中转传统开胸手术。1例72岁肺癌患者肺叶切除术后第8天并发双肺感染致呼吸衰竭死亡,其余41例无手术并发症。41例随访6~47个月,平均18个月,其中32例肺癌随访8~47个月,3例分别于术后8、11、17个月出现肝脏、双肺转移死亡。结论胸腔镜辅助小切口行解剖肺叶及全肺切除术是可行的。     

Pulmonary embolism and cerebral venous thrombosis after thoracoscopic surgery for benign pulmonary disease

A-76-year-old woman consulted for open biopsy for a pulmonary mass. Thoracoscopic wedge resection was performed. The lesion was histologically diagnosed as nonspecific inflammation. On the first postoperative day (POD1), the patient lost consciousness transiently. Eleven hours after the first stroke, the patient experienced a second stroke together with hypoxia. Pulmonary perfusion scan on POD2 showed multiple perfusion defects, and the patient was diagnosed with pulmonary embolism (PE). Thrombolitic therapy was started. Neurological symptoms didn’t improve, and cerebral angiography on POD3 showed delayed perfusion in superficial veins. The patient was diagnosed with cerebral venous thrombosis (CVT). Thrombolytic and anticoagulant therapy had been continued, and the patient was found to have hemorrhagic cerebral infarction on POD11. After persistent therapy, the patient was discharged on POD120. Although both PE and CVT are rare complications after thoracic surgery, we must consider these complications in patients undergoing thoracic operations including thoracoscopic surgery.