175例小儿连续胸腔镜肺切除术回顾性研究

目的 探讨胸腔镜肺切除术在治疗婴幼儿和儿童肺部病变的安全性和有效性.方法 回顾性研究2014年9月至2016年6月间一组在北京儿童医院收治的需要肺切除的患儿,总结分析175例病例的临床资料、手术方法、手术效果及术后病理.结果 175例病例均顺利完成手术,无严重并发症及二次开胸的病例.175例中,男100例,女75例.年龄2个月至13岁10个月,平均(18.5±41.6)个月;手术时间15～120min,平均(75.0±37.9) min;出血量1～300ml,平均(5.0±26.9)ml.中转开胸7例,中转开腹1例,中转率4.6％.术后病理:先天性肺气道畸形即肺囊性腺瘤样畸形(CPAM) 105例、隔离肺47例、肺部肿瘤9例、肺气肿6例、肺囊肿4例、肺血管淋巴管畸形1例,肺动静脉瘘1例、肺寄生虫性肉芽肿1例.结论 婴幼儿和儿童的肺部病变可以经过胸腔镜治疗,且胸腔镜肺切除术是安全和有效的.腔镜的微创手术可以降低手术创伤,减轻术后疼痛,缩短住院时间,同时减小手术切口,伤口美观.

Video-assisted thoracoscopic lobectomy in children: a retrospective single-center study with 175 consecutive cases

Objective To evaluate the safety and efficacy of video-assisted thoracoscopy for lung diseases in infants and children.Methods From September 2014 to June 2016,a retrospective review was conducted for 175 consecutive patients undergoing video-assisted thoracoscopy.Clinical data,surgical procedures,surgical findings and postoperative pathological examinations were analyzed.Results All procedures were successfully completed.There was no single case of severe complication or re-operation.There were 100 boys and 75 girls.The mean age was (18.5 ± 41.6)(2-156) months,mean operative duration (75.0 ± 37.9) (15-120) minutes and mean blood loss (5.0 ± 26.9)(1-300)ml.There were conversions into open thoracotomy (n =7) and open laparotomy (n =1,4.6％).Postoperative pathological examinations revealed lung cystic adenomatoid malformations,i.e.congenital pulmonary airway abnormalities (CPAM,n =105),pulmonary sequestration (n =47),lung tumor (n =9),emphysema (n =6),pulmonary cyst (n =4),pulmonary vascular lymphatic malformation (n =1),pulmonary arteriovenous fistula (n =1) and pulmonary parasitic granuloma (n =1).Conclusions Safe and effective for pulmonary resection,video-assisted thoracoscopy is indicated for treating lung diseases in infants and children.This minimally invasive approach offers less surgical trauma,minor postoperative pains and shorter hospitalization stay.In addition,operative scar is smaller and cosmetic outcomes are better.