中华小儿外科杂志
中華小兒外科雜誌
중화소인외과잡지
Chinese Journal of Pediatric Surgery
2015年
8期
594-598
,共5页
徐畅%向波%罗启成%杜斌%蒋小平
徐暢%嚮波%囉啟成%杜斌%蔣小平
서창%향파%라계성%두빈%장소평
胸腔镜%肺外科手术%儿童%治疗
胸腔鏡%肺外科手術%兒童%治療
흉강경%폐외과수술%인동%치료
Thoracoscopes%Pulmonary surgical procedures%Child%Therapy
目的 回顾性分析我院接受胸腔镜肺叶切除的病例,拟总结儿童胸腔镜肺叶切除手术经验.方法 回顾性研究2011年7月至2014年1月在我院接受胸腔镜肺叶切除的病例,对所有患儿的手术治疗情况及术后恢复情况进行分析和总结.结果 本组患儿共21例,男13例,女8例,年龄4个月至12岁.其中左肺下叶切除6例,左肺上叶3例,右肺下叶7例,右肺上叶2例,叶外型隔离肺单纯切除异常肺叶3例.术中10例患儿单肺通气,11例患儿双肺通气.3例患儿因反复肺部感染,胸腔内粘连较重,1例患儿因术中出血,转为开放,其余病例在腔镜下顺利完成手术.在全胸腔镜肺叶切除的患儿中,术中出血5～40 ml,手术时间40～130 min.术后病检提示:肺腺瘤样囊性病10例,叶内型隔离肺7例,叶外型隔离肺3例,肺纤维母细胞瘤1例.胸腔镜肺叶切除患儿于术后3～4d拔除胸腔闭式引流管,术后5～7 d出院,无肺部感染、肺不张、出血、支气管胸膜瘘等术后并发症发生.中转开放的4例患几分别于术后10～14 d出院.近期随访中,所有患儿均恢复良好,复查胸片或CT见患侧剩余肺叶代偿良好.结论 胸腔镜肺叶切除具有创伤小、术中显露清楚、手术时间短、术后患儿痛苦小、恢复快、呼吸系统并发症少等优点,在儿童中有较好可行性.术中是否建立单肺通气、患儿年龄和体型大小、叶间裂发育程度以及术前是否反复肺部感染导致胸腔粘连是影响手术操作难度的主要因素.
目的 迴顧性分析我院接受胸腔鏡肺葉切除的病例,擬總結兒童胸腔鏡肺葉切除手術經驗.方法 迴顧性研究2011年7月至2014年1月在我院接受胸腔鏡肺葉切除的病例,對所有患兒的手術治療情況及術後恢複情況進行分析和總結.結果 本組患兒共21例,男13例,女8例,年齡4箇月至12歲.其中左肺下葉切除6例,左肺上葉3例,右肺下葉7例,右肺上葉2例,葉外型隔離肺單純切除異常肺葉3例.術中10例患兒單肺通氣,11例患兒雙肺通氣.3例患兒因反複肺部感染,胸腔內粘連較重,1例患兒因術中齣血,轉為開放,其餘病例在腔鏡下順利完成手術.在全胸腔鏡肺葉切除的患兒中,術中齣血5～40 ml,手術時間40～130 min.術後病檢提示:肺腺瘤樣囊性病10例,葉內型隔離肺7例,葉外型隔離肺3例,肺纖維母細胞瘤1例.胸腔鏡肺葉切除患兒于術後3～4d拔除胸腔閉式引流管,術後5～7 d齣院,無肺部感染、肺不張、齣血、支氣管胸膜瘺等術後併髮癥髮生.中轉開放的4例患幾分彆于術後10～14 d齣院.近期隨訪中,所有患兒均恢複良好,複查胸片或CT見患側剩餘肺葉代償良好.結論 胸腔鏡肺葉切除具有創傷小、術中顯露清楚、手術時間短、術後患兒痛苦小、恢複快、呼吸繫統併髮癥少等優點,在兒童中有較好可行性.術中是否建立單肺通氣、患兒年齡和體型大小、葉間裂髮育程度以及術前是否反複肺部感染導緻胸腔粘連是影響手術操作難度的主要因素.
목적 회고성분석아원접수흉강경폐협절제적병례,의총결인동흉강경폐협절제수술경험.방법 회고성연구2011년7월지2014년1월재아원접수흉강경폐협절제적병례,대소유환인적수술치료정황급술후회복정황진행분석화총결.결과 본조환인공21례,남13례,녀8례,년령4개월지12세.기중좌폐하협절제6례,좌폐상협3례,우폐하협7례,우폐상협2례,협외형격리폐단순절제이상폐협3례.술중10례환인단폐통기,11례환인쌍폐통기.3례환인인반복폐부감염,흉강내점련교중,1례환인인술중출혈,전위개방,기여병례재강경하순리완성수술.재전흉강경폐협절제적환인중,술중출혈5～40 ml,수술시간40～130 min.술후병검제시:폐선류양낭성병10례,협내형격리폐7례,협외형격리폐3례,폐섬유모세포류1례.흉강경폐협절제환인우술후3～4d발제흉강폐식인류관,술후5～7 d출원,무폐부감염、폐불장、출혈、지기관흉막루등술후병발증발생.중전개방적4례환궤분별우술후10～14 d출원.근기수방중,소유환인균회복량호,복사흉편혹CT견환측잉여폐협대상량호.결론 흉강경폐협절제구유창상소、술중현로청초、수술시간단、술후환인통고소、회복쾌、호흡계통병발증소등우점,재인동중유교호가행성.술중시부건립단폐통기、환인년령화체형대소、협간렬발육정도이급술전시부반복폐부감염도치흉강점련시영향수술조작난도적주요인소.
Objective To review the cases of thoracoscopic lobectomy and summarize the experiences of thoracoscopic lobectomy in children.Methods We reviewed all cases of thoracoscopic lobectomy at our hospital from June 2011 to January 2014.The intraoperative findings and postoperative outcomes were analyzed.Results There were 13 males and 8 females with an age range of 4 months to 11 years.The locations were left lower (n =6),left upper (n =3),right lower (n =7),right upper lobe (n =2) and extrapulmonary sequestration (n =3).Ten patients accepted onequng ventilation while the remainder bilateral ventilation.Conversion was required because of adhesion (n =3) and hemorrhage (n =1).In thoracoscopic cases,the range of operative duration was 40-130 min and hemorrhage was estimated at 5-40 ml.The postoperative pathologic examinations confirmed congenital cystic adenomatoid malformation (n =10),intrapulmonary sequestration (n =7),extrapulmonary sequestration (n =3) and fibroblastoma (n =1).For thoracoscopic cases,chest tubes were removed at Days 3-4 and were discharged at Days 5-7 postoperation.There were no postoperative complications.The converted cases were discharged at Days 10-14 postoperation.The short-term prognosis was all fair.Condusions Thoracoscopic lobectomy offers many advantages of miniinvasiveness,better intraoperative exposure,shorter operative duration,minimal postoperative pain,rapid recovery and fewer respiratory complications.It is ideal for children.Differential ventilation,history of pneumonia,individual age,body built and incomplete fissure are the major influencing factors of operative difficulty.
