Thoracoscopic Lobectomy in Infants and Children Utilizing a 5 mm Stapling Device.
Thoracoscopic Lobectomy in Infants and Children Utilizing a 5 mm Stapling Device.
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DOI：
10.1089/lap.2016.0334
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发表时间：
2016-12
期刊：
影响因子：
--
通讯作者：
Rothenberg S
中科院分区：
文献类型：
--
作者：
Rothenberg S
目的：胸腔镜肺切除术治疗先天性肺囊性疾病已成为公认的和许多机构的首选技术。然而，技术上的挑战很多。以前成人常用的内窥镜吻合器(12 mm)对于婴儿来说太大了，这项研究评估了使用5 mm吻合器密封和分离主要肺结构的安全性和有效性。方法：自2014年7月至2016年3月，26例6周~13个月大的婴幼儿在胸腔镜行肺叶切除术，行CPAM或肺隔离术。体重范围为3.2~11.4 kg。其中上叶切除7例，中叶切除2例，下叶切除17例。在每个病例中，5 mm的吻合器(Just Right Surgical；路易斯维尔，科罗拉多州)是血管和支气管密封和分离的主要设备。它的直径为4.8 mm，砧座长度为25 mm，并放置四排钉子，并在它们之间进行分割。采用3 mm封闭器进行解剖，必要时取小段血管。对所有病例的残端管路进行出血或漏气评估。结果：所有手术均在胸腔镜下顺利完成。24例患者的主干动脉、静脉、5例大血管、26例支气管处均使用了吻合器。1例小裂隙用吻合器缝合，1例大裂隙缝合。总共发射了96枚订书钉。手术时间35~135分钟。血管残端未见明显出血。在1例中，支气管残端的边缘必须加强，这被认为是次要的，因为颌骨内包裹了太多的组织。无术后并发症。结论：5 mm吻合器在婴幼儿胸腔镜肺叶切除术中安全有效。它允许通过单一的5 mm端口安全地管理婴儿受限胸腔内的主要肺血管和支气管。
Purpose: Thoracoscopic lobectomy for congenital cystic lung disease has become an accepted and in many institutions the preferred technique. However, the technical challenges are many. Previous endoscopic staplers (12 mm) used commonly in adults are too large for use in infants This study evaluates the safety and efficacy of using a 5 mm stapling device to seal and divide major pulmonary structures. Methods: From July 2014 to March 2016, 26 patients of age 6 weeks to 13 months underwent thoracoscopic lobectomy for CPAM or sequestration. Weights ranged from 3.2 to 11.4 kg. There were 7 upper lobectomies, 2 middle, and 17 lower lobectomies. In each case, the 5 mm stapler (Justright Surgical; Louisville, Colorado) was the primary device for vessel and bronchial sealing and division. It is 4.8 mm in diameter with an anvil length of 25 mm and lays down four rows of staples and divides between them. A 3 mm sealing device was used for dissection and to take smaller segmental vessels as necessary. Stump lines were evaluated for bleeding or air leak in all cases. Results: All procedures were accomplished successfully thoracoscopically. The stapler was used on the main lobar artery cases and vein in 24 cases, a large systemic sequestration vessel in 5 cases, and the bronchus in all 26. The stapler was also used to complete the minor fissure in 1 case and the major fissure in 1 case. A total of 96 staple loads were fired. Operative times ranged from 35 to 135 minutes. There was no significant bleeding of any vascular stump. In 1 case, the edge of the bronchial stump had to be reinforced, this was thought to be secondary to too much tissue being enclosed in the jaws. There were no postoperative complications. Conclusion: The use of a 5 mm stapling device appears to be safe and effective in thoracoscopic lobectomy in infants. It allows for safe management of major pulmonary vessels and bronchi in the confined chest of an infant through a single 5 mm port.
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