Thoracoscopic Lobectomy in Infants Less Than 10 kg with Prenatally Diagnosed Cystic Lung Disease
Thoracoscopic Lobectomy in Infants Less Than 10 kg with Prenatally Diagnosed Cystic Lung Disease
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DOI：
10.1089/lap.2010.0138
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发表时间：
2011-03-01
影响因子：
1.3
通讯作者：
Stolar, Charles J.
中科院分区：
文献类型：
--
作者：
Rothenberg, Steven S.;Kuenzler, Keith A.;Stolar, Charles J.
目的：胸腔镜肺叶切除术治疗先天性囊性肺病变是小儿外科公认的技术。由于越来越多的这些病变是产前检测，婴儿切除术的安全性和有效性受到质疑。我们回顾了我们的经验，在10年的时间内，以评估早期切除这些lesions.Methods：从2001年1月至2009年8月，75例1岁以下，体重< 10公斤进行胸腔镜肺叶切除术在两个机构。患者进行了以下诊断：52先天性囊性腺瘤样畸形，20支气管肺隔离症，3先天性肺叶肺气肿。所有病变均在出生后通过计算机断层扫描证实。手术时患者年龄从4天到11个月不等，患者体重从3.1到10公斤。结果：75个肺叶切除术74胸腔镜完成。上叶切除16例，中叶切除1例，下叶切除55例。手术时间为45 - 225分钟。住院时间为1至5天。26名患者的一个子集在年龄小于3个月且< 5 kg的情况下进行了手术，尽管无症状。结论：胸腔镜肺叶切除术对体重< 10 kg的婴幼儿是安全的，避免了开胸手术的并发症。早期对年轻患者进行手术可以避免与临床明显和亚临床感染相关的炎症变化，即使是体重< 5 kg的患者。这可能会降低手术的技术挑战性，并可能导致较低的并发症和转换率。
Purpose: Thoracoscopic lobectomy for congenital cystic lung lesions is an accepted technique in pediatric surgery. Since an increasing number of these lesions are detected prenatally, the safety and efficacy of infant resections have been questioned. We reviewed our experience over a 10-year period to evaluate early resection of these lesions.Methods: From January 2001 to August 2009, 75 patients under 1 year of age and weighing < 10 kg underwent thoracoscopic lobectomy at two institutions. Patients carried the following diagnoses: 52 had congenital cystic adenomatoid malformation, 20 had bronchopulmonary sequestration, and 3 had congenital lobar emphysema. All lesions were confirmed after birth by computed tomography scan. Patient age at operation ranged from 4 days to 11 months and patient weight from 3.1 to 10 kg.Results: Seventy-four of 75 lobectomies were thoracoscopically completed. There were 16 upper lobectomies, 1 middle lobectomy, and 55 lower lobectomies. Operative time ranged from 45 to 225 minutes. Hospital length of stay ranged from 1 to 5 days. A subset of 26 patients had surgery younger than 3 months of age and < 5 kg, despite being asymptomatic. Their operative time averaged 90 minutes, and mean length of hospital stay was 1.5 days.Conclusion: Thoracoscopic lobectomy is safe for infants < 10 kg and avoids the morbidity associated with thoracotomy. Operating early on younger patients may avoid the inflammatory changes associated with both clinically apparent and subclinical infections, even in patients weighing < 5 kg. This may make the procedures less technically challenging and may result in lower complication and conversion rates.