The first 100 infant thoracoscopic lobectomies: Observations through the learning curve and comparison to open lobectomy
The first 100 infant thoracoscopic lobectomies: Observations through the learning curve and comparison to open lobectomy
复制标题
DOI：
10.1016/j.jpedsurg.2015.05.015
复制
发表时间：
2015-11-01
影响因子：
2.4
通讯作者：
Flake, Alan W.
中科院分区：
文献类型：
--
作者：
Laje, Pablo;Pearson, Erik G.;Flake, Alan W.
目的：这项研究的目的是描述我们最初尝试的100例婴儿胸腔镜肺叶切除术治疗无症状的产前诊断的肺部病变，并将结果与同期年龄匹配的接受开放式肺叶切除术的患者进行比较。背景：婴儿胸腔镜肺叶切除术是一种技术上具有挑战性的手术，近年来才在全球范围内获得认可。这是对2005年3月至2014年1月期间接受胸腔镜或开放式肺叶切除术的所有患者的回顾性审查。包括所有年龄小于4个月的无症状婴儿。排除的患者进行紧急肺叶切除术和孤立的叶外支气管肺隔离症。结果：共100尝试胸腔镜肺叶切除术与188开放肺叶切除术进行了比较。在胸腔镜组中，手术时的平均年龄和体重为7.3周和4.8 kg，平均手术时间为185分钟，平均住院时间为3天。中转开放12例（12%）。在该系列的前三分之一内发生了十次转换，而在最后三分之一内没有发生。没有人员死亡。胸腔镜组和开放组在围手术期并发症或住院时间方面没有差异。手术时间存在显著差异：111分钟vs. 185分钟（开放vs.胸腔镜; p < 0.001）。胸腔镜组平均呼气末二氧化碳（ETCO 2）高于开放组，平均外周毛细血管血氧饱和度（SpO 2）低于开放组（分别为51.7与38.6 mmHg和97.5与99.1%）。在高容量中心，可以克服胸腔镜肺叶切除术的学习曲线，并且可以以等同的结局进行手术，在我们看来，上级美容效果优于开放式肺叶切除术。(C)2015 Elsevier Inc. All rights reserved.
Objective: The objective of the study is to describe our initial 100 attempted infant thoracoscopic lobectomies for asymptomatic, prenatally diagnosed lung lesions, and compare the results to contemporaneous age-matched patients undergoing open lobectomy.Background: Infant thoracoscopic lobectomy is a technically challenging procedure, which has only gained acceptance worldwide in recent years.Methods: This is a retrospective review of all patients undergoing thoracoscopic or open lung lobectomy between March 2005 and January 2014. Included were all asymptomatic infants younger than 4 months. Excluded were patients undergoing emergent lobectomy and patients with isolated extralobar bronchopulmonary sequestrations.Results: A total of 100 attempted thoracoscopic lobectomies were compared with 188 open lobectomies. In the thoracoscopic group, mean age and weight at surgery were 7.3 weeks and 4.8 kg, mean operative time was 185 minutes, and mean hospital stay was 3 days. Twelve cases were converted to open (12%). Ten conversions occurred within the first third of the series and none in the last third. There were no mortalities. There were no differences between the thoracoscopic and open groups in perioperative complications or hospital stay. There was a significant difference in the operative time: 111 minutes vs. 185 minutes (open vs. thoracoscopic; p < 0.001). There was a higher mean end-tidal carbon dioxide (ETCO2) and lower mean peripheral capillary oxygen saturation (SpO(2)) in the thoracoscopic group versus the open group (51.7 versus 38.6 mmHg and 97.5 versus 99.1%, respectively).Conclusion: In high volume centers, the learning curve of thoracoscopic lobectomy can be overcome and the procedure can be performed with equivalent outcomes and, in our opinion, superior cosmetic results to open lobectomy. (C) 2015 Elsevier Inc. All rights reserved.