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J Zhejiang Univ (Med Sci)  2018, Vol. 47 Issue (3): 272-277    DOI: 10.3785/j.issn.1008-9292.2018.06.09
    
Endoscopic lobectomy for 47 children with pulmonary sequestration
HUANG Ting(),ZHANG Xiaole,LIANG Liang,TAN Zheng,GAO Yue,LI Jianhua*(),SHU Qiang
the Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
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Abstract  

Objective: To evaluate the feasibility of endoscopic lobectomy for pulmonary sequestration in children. Methods: Clinical data of 47 children with pulmonary sequestration treated with endoscopic lobectomy from April 2015 to November 2017 were reviewed. According to the operation date, 19 children received operation from April 2015 to December 2016 were early group, and 23 children received operation from January 2017 to November 2017 were late group (5 children with lesions inside diaphragm were excluded). The operation time, intraoperative blood loss, retention time of drainage tube, length of hospital stay and incidence of complications were compared between two groups. Results: Among 47 children, endoscopic lobectomy was successfully completed in 45 children, and the rest 2 children were converted to thoracotomy. No death was observed. The operation time in late group was shorter than that in the early group (P < 0.05), and the intraoperative blood loss of the late group was less than that of early group (P < 0.05); while there were no significant differences in retention time of drainage tube and length of hospital stay between two groups (both P>0.05). Postoperative complications occurred in 14 children, including 4 cases of pneumothorax, 8 cases of pleural effusion, 1 case of pulmonary infection, and 1 case of diaphragmatic hernia. The incidence rates of postoperative complications in late group and early group were 17.4% (4/23) and 42.1% (8/19), and the difference was not statistically significant(P>0.05). During the follow-up (2-26 months), no relapse and thoracic collapes were observed, and CT examination found that the remaining lungs were well compensated in all children. Conclusion: The endoscopic lobectomy is effective and safe with less trauma and bleeding, which is recommended for treatment of pulmonary sequestration in children.



Key wordsBronchopulmonary sequestration/surgery      Thoracoscopy/methods      Child     
Received: 23 March 2018      Published: 18 September 2018
CLC:  R726.2  
  R65  
Corresponding Authors: LI Jianhua     E-mail: 6512045@zju.edu.cn;lijh@zju.edu.cn
Cite this article:

HUANG Ting,ZHANG Xiaole,LIANG Liang,TAN Zheng,GAO Yue,LI Jianhua,SHU Qiang. Endoscopic lobectomy for 47 children with pulmonary sequestration. J Zhejiang Univ (Med Sci), 2018, 47(3): 272-277.

URL:

http://www.zjujournals.com/med/10.3785/j.issn.1008-9292.2018.06.09     OR     http://www.zjujournals.com/med/Y2018/V47/I3/272


腔镜手术治疗肺隔离症患儿47例

目的: 探讨腔镜手术治疗肺隔离症患儿的可行性。方法: 回顾性分析浙江大学医学院附属儿童医院2015年4月至2017年11月诊治的47例肺隔离症患儿的临床资料。根据手术开展时间,将2015年4月至2016年12月手术的19例患儿归为前期手术组,2017年1月至2017年11月手术的23例患儿归为后期手术组(5例膈肌内肺隔离症患儿由于类型特殊未参与分组)。比较前期手术组和后期手术组手术时间、术中出血量、术后引流管留置天数、术后住院天数和术后并发症的发生率等指标。结果: 47例患儿中,2例中转开胸,其余45例患儿均顺利完成腔镜手术,无手术死亡。后期手术组手术时间较前期手术组缩短(P < 0.05),术中出血量较前期手术组减少(P < 0.05),但引流管留置天数和术后住院天数与前期手术组差异无统计学意义(均P>0.05)。14例患儿发生术后并发症(气胸4例、胸腔积液8例,肺部感染1例,膈疝1例),其中后期手术组术后并发症的发生率为17.4%(4/23),较前期手术组(8/19,42.1%)降低,但差异无统计学意义(P>0.05)。术后随访2~26个月,所有患儿无复发及胸廓塌陷,剩余肺代偿良好。结论: 腔镜手术治疗肺隔离症患儿创伤小,出血少,术后恢复快,安全可行。


关键词: 支气管肺隔离症/外科学,  胸腔镜检查/方法,  儿童 
Fig 1 Incisions for thoracoscopic surgery and laparoscopic surgery
[$\bar x \pm s$或M(Q1~Q3)]
组别 n 手术时间(h) 术中出血量(mL) 术后引流管留置天数(d) 术后住院天数(d)
与前期手术组比较,*P<0.05.
前期手术组 19 1.6±0.9 5(5~10) 3(3~4) 9(7~12)
后期手术组 23 0.9±0.5* 5(2~5)* 3(2~4) 7(7~9)
Tab 1 Comparison of surgical indexes between early stage group and recent operation group
[1]   蔡威, 孙宁, 魏光辉 . 小儿外科学[M]. 5版 北京: 人民卫生出版社, 2014: 224- 225
CAI Wei , SUN Ning , WEI Guanghui . Pediatric surgery[M]. 5th ed Beijing: People's Medical Publishing House, 2014: 224- 225
[2]   梁小碧, 李渝芬, 曾少颖 et al. 肺隔离症3种手术方式结果的比较分析[J]. 岭南心血管病杂志, 2015, 21 (2): 187- 190
LIANG Xiaobi , LI Yufen , ZENG Shaoying et al. Comparison analysis of three kinds of operational approaches for pulmonary sequestration[J]. South China Journal of Cardiovascular Diseases, 2015, 21 (2): 187- 190
doi: 10.3969/j.issn.1007-9688.2015.02.014
[3]   STANTON M , NJERE I , ADE-AJAYI N et al. Systematic review and meta-analysis of the postnatal management of congenital cystic lung lesions[J]. J Pediatr Surg, 2009, 44 (5): 1027- 1033
doi: 10.1016/j.jpedsurg.2008.10.118
[4]   COOK J , CHITTY L S , DE COPPI P et al. The natural history of prenatally diagnosed congenital cystic lung lesions:long-term follow-up of 119 cases[J]. Arch Dis Child, 2017, 102 (9): 798- 803
doi: 10.1136/archdischild-2016-311233
[5]   HONG C , YU G , TANG J et al. Risk analysis and outcomes of bronchopulmonary sequestrations[J]. Pediatr Surg Int, 2017, 33 (9): 971- 975
doi: 10.1007/s00383-017-4097-0
[6]   俞钢 . 临床胎儿学[M]. 北京: 人民卫生出版社, 2015: 193- 198
YU Gang . Clinic fetology[M]. Beijing: People's Medical Publishing House, 2015: 193- 198
[7]   SINGH R , DAVENPORT M . The argument for operative approach to asymptomatic lung lesions[J]. Semin Pediatr Surg, 2015, 24 (4): 187- 195
doi: 10.1053/j.sempedsurg.2015.02.003
[8]   STANTON M . The argument for a non-operative approach to asymptomatic lung lesions[J]. Semin Pediatr Surg, 2015, 24 (4): 183- 186
doi: 10.1053/j.sempedsurg.2015.01.014
[9]   ARJUN P , PALANGADAN S , HAQUE A et al. Intralobar sequestration[J]. Lung India, 2017, 34 (6): 559- 561
doi: 10.4103/lungindia.lungindia_51_17
[10]   SIMOGLOU C , LAWAL L A . Adenocarcinoma in pulmonary sequestration:a case report and literature review[J]. Asian Cardiovasc Thorac Ann, 2015, 23 (9): 1119- 1120
doi: 10.1177/0218492315589200
[11]   NOWAK K , DER THVSEN J V , KARENOVICS W et al. Pulmonary sequestration with haemoptysis and an unsuspected carcinoid tumour[J]. Gen Thorac Cardiovasc Surg, 2013, 61 (8): 479- 482
doi: 10.1007/s11748-012-0148-6
[12]   ZELTNER T B , CADUFF J H , GEHR P et al. The postnatal development and growth of the human lung. I. Morphometry[J]. Respir Physiol, 1987, 67 (3): 247- 267
doi: 10.1016/0034-5687(87)90057-0
[13]   WERNER H A , PIRIE G E , NADEL H R et al. Lung volumes, mechanics, and perfusion after pulmonary resection in infancy[J]. J Thorac Cardiovasc Surg, 1993, 105 (4): 737- 742
[14]   LI Q , XIE D , SIHOE A et al. Video-assisted thoracic surgery is associated with better short-term outcomes than open thoracotomy in adult patients with intralobar pulmonary sequestration[J]. Interact Cardiovasc Thorac Surg, 2018, 26 (2): 284- 287
doi: 10.1093/icvts/ivx311
[15]   LANSDALE N , ALAM S , LOSTY P D et al. Neonatal endosurgical congenital diaphragmatic hernia repair:a systematic review and meta-analysis[J]. Ann Surg, 2010, 252 (1): 20- 26
doi: 10.1097/SLA.0b013e3181dca0e8
[16]   谭征, 李建华, 梁靓 et al. 胸腔镜小儿肺叶切除术50例[J]. 中华胸心血管外科杂志, 2017, 33 (8): 490- 492
TAN Zheng , LI Jianhua , LIANG Liang et al. Thoracoscopic lobectomy in infants and children[J]. Chinese Journal of Thoracic and Cardiovascular Surgery, 2017, 33 (8): 490- 492
doi: 10.3760/cma.j.issn.1001-4497.2017.08.009
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