Sparing-lung surgery for the treatment of congenital lung malformations
Sparing-lung surgery for the treatment of congenital lung malformations
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DOI：
10.1016/j.jpedsurg.2013.02.098
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发表时间：
2013-07-01
影响因子：
2.4
通讯作者：
Lima, Mario
中科院分区：
文献类型：
--
作者：
Fascetti-Leon, Francesco;Gobbi, Dalia;Lima, Mario
目的：先天性肺畸形（CLM）的传统治疗方法是肺叶切除术。手术的首要指征是这些病变易发生呼吸道感染和恶性肿瘤。由于产前诊断水平的提高，大多数患者都能及时、准确地接受手术治疗。在这种情况下，肺保留手术（LS）作为一种肺保护策略，特别是对于无症状患者，已经引起了人们的兴趣。在本研究中，我们评估了胸腔镜和开放式保肺切除术作为替代肺叶切除术CLM receivation.Methods：我们回顾性分析了所有患者进行肺保留切除术（肺段切除术和非典型切除术）CLM从2001年至2010年。数据收集术前诊断检查，干预类型，并follow up.Results：五十四例患者在研究期间接受了LS CLM。26例经胸腔镜入路，18例需要开放转换为完全切除。有6例术后并发症：3例无症状气胸，无需干预即可解决，1例张力性气胸需要更换引流导管，3例术中出血需要输血。平均随访时间为65.2个月。2例患者在随访期间发生肺炎。第三个病人有一个囊性肺病变的术后计算机断层扫描（CT），需要二次looksurgery.Conclusions：LS CLM是一种安全有效的手段，肺实质保护儿科患者。并发症发生率与传统肺叶切除术相当。根据我们的经验，如果在选定的患者中准确计划，这种类型的肺手术不会带来较高的残留疾病和复发风险，即，那些有小的无症状病变。并发症发生率是可接受的，显然不受术前症状的影响。建议采用胸腔镜入路，但应提倡开放性手术，以避免手术时间过长。(C)2013年由Elsevier Inc.出版
Purpose: Congenital lung malformations (CLM) are traditionally treated by pulmonary lobectomy. The foremost indication for surgery is that these lesions predispose to respiratory tract infections and to malignancy. Owing to the improvement of prenatal diagnosis, most patients are operated in a timely manner and prophylactically. In this context, lung-sparing surgery (LS) has gained interest as a lung preservation strategy, especially for asymptomatic patients. In the present study, we evaluated both thoracoscopic and open lung-preserving resections as an alternative to lobectomy for CLM resection.Methods: We retrospectively reviewed all patients who underwent lung-sparing resection (segmentectomy and atypical resection) for CLM from 2001 to 2010. Data were collected regarding preoperative diagnostic workup, type of intervention, and follow up.Results: Fifty-four patients received LS for CLM during the study period. Twenty-six were approached thoracoscopically, with 18 cases requiring open conversion for a complete resection. There were six postoperative complications: three asymptomatic pneumothoraces that resolved without intervention, one tension pneumothorax that required replacement of a drainage catheter, and three instances of intraoperative bleeding requiring blood transfusion. Mean duration of follow-up was 65.2 months. Two patients experienced pneumonia during the follow-up period. A third patient had a cystic lung lesion on postoperative computed tomography (CT) which required a second-look surgery.Conclusions: LS for CLM is a safe and effective means of lung parenchymal preservation in pediatric patients. Complication rates are comparable to that of traditional lobectomy. In our experience, this type of lung surgery does not carry a higher risk of residual disease and recurrence if accurately planned in selected patients, i.e., those with small asymptomatic lesions. The complication rate is acceptable and apparently not affected by preoperative symptoms. The thoracoscopic approach is recommended, although open conversion should be advocated to avoid too long operative times. (C) 2013 Published by Elsevier Inc.