您的位置：山东大学 -> 科技期刊社 -> 《山东大学学报（医学版）》

山东大学学报 (医学版) ›› 2024, Vol. 62 ›› Issue (1): 57-62.doi: 10.6040/j.issn.1671-7554.0.2023.0995

• 临床医学 • 上一篇    下一篇

单术者双孔法在电视辅助胸腔镜手术治疗儿童叶外型肺隔离症中的早期临床应用

吕龙飞1,2,李继如3,翟允鹏1,2,赵华善1,2,郭锐1,2,许洪修1,2,黄赛1,2,张士松1,2   

  • 发布日期:2024-02-02
  • 通讯作者: 张士松. E-mail: zsli323@163.com
  • 基金资助:
    济南市卫生健康委员会科技计划项目(2023-2-132,2023-2-129);山东大学附属儿童医院高层次科研项目培育计划项目(SDFE-GCC2023005)

Early clinical application of “single-surgeon double-incision method” in video-assisted thoracoscopic surgery in the treatment of the children with extralobar sequestration

LYU Longfei1,2, LI Jiru3, ZHAI Yunpeng1,2, ZHAO Huashan1,2, GUO Rui1,2, XU Hongxiu1,2, HUANG Sai1,2, ZHANG Shisong1,2   

  1. 1. Department of Thoracic and Oncological Surgery, Childrens Hospital Affiliated to Shandong University, Jinan 250000, Shandong, China;
    2. Department of Thoracic and Oncological Surgery, Jinan Childrens Hospital, Jinan 250000, Shandong, China;
    3. Department of Pediatric Surgery, Jinxiang Peoples Hospital, Jinxiang 272200, Shandong, China
  • Published:2024-02-02

PDF (PC)

211

摘要： 目的 总结单术者双孔法在电视辅助胸腔镜手术治疗儿童叶外型肺隔离症中的操作流程,评价此术式临床推广应用的可行性及安全性。 方法 回顾性收集 2020年1月至2023年8月由山东大学附属儿童医院胸外肿瘤外科同一术者完成手术的45例膈肌上型叶外型肺隔离症患者的临床资料。根据手术方式不同分为双孔组(n=15)和三孔组(n=30),其中双孔组患者男11例,女4例,年龄4~19个月,三孔组患者男21例,女9例,年龄3~59个月,通过秩和检验、t检验及Fisher精确检验比较手术时间、术中出血量、住院时间、住院费用及术后并发症发生率等临床参数。 结果 所有患者均顺利完成手术,未术中中转开放手术。与三孔组相比,双孔组患者的平均住院费用更低(31 165元vs 35 555元, t=-6.093, P<0.001,手术时间更短(40 min vs 45 min, Z=-2.322, P=0.020),住院时间更短(5 d vs 6 d, Z=-3.519, P<0.001),胸壁切口长度更短(1.0 cm vs 1.6 cm, Z=-5.489, P<0.001)。两组患者术中出血量及术后并发症的发生率差异无统计学意义。 结论 单术者双孔法在微创电视胸腔镜手术治疗儿童叶外型肺隔离症中操作简便、安全可行,可缩短患者的手术时间及住院时间、减小患者胸壁切口的长度、节省患者的住院费用,更加符合当今加速康复外科的理念,值得临床进一步推广应用。

关键词: 双孔胸腔镜, 叶外型肺隔离症, 儿童, 微创, 加速康复外科

Abstract: Objective To summarize the operation process of “single-surgeon double-incision method” in video-assisted thoracoscopic surgery in the treatment of the children with extralobar sequestration, and to evaluate the feasibility and safety of this operation. Methods The clinical data of 45 patients operated on by the same surgeon in the Childrens Hospital Affiliated to Shandong University during Jan. 2020 and Aug. 2023 were retrospectively collected. According to different surgical methods, the patients were divided into double-incision group(n=15, 11 males and 4 females, aged 4 to 19 months)and three-incision group(n=30, 21 males and 9 females, aged 3 to 59 months). The operation time, intraoperative blood loss, hospital stay, hospital costs and incidence of postoperative complications were compared with rank-sum test, t test and Fisher exact test. Results All operations were successfully completed, without conversion to open surgery. The double-incision group had lower hospital costs(31,165 vs. 35,555 Yuan, t=-6.093, P<0.001), shorter operation time(40 vs. 45 min, z=-2.322, P=0.020), shorter hospital stay(5 vs. 6 d, z=-3.519, P<0.001), and shorter length of chest wall incision(1.0 vs. 1.6 cm, z=-5.489, P<0.001). There were no significant differences in the amount of intraoperative blood loss and incidence of postoperative complications between the two groups. Conclusion Single-surgeon double-incision method is simple, safe and feasible in minimally invasive video-assisted thoracoscopic surgery in the treatment of the children with extralobar sequestration, which reduces the operation time, hospital stay, length of chest wall incision, and hospital costs. It is in line with the concept of enhanced recovery after surgery, and worthy of promotion and application in clinical practice.

Key words: Double-incision thoracoscope, Extralobar sequestration, Children, Minimally invasive, Enhanced recovery after surgery

中图分类号: 

  • R615
[1] 李潇, 蔡纯, 孙宇玲, 等. 单孔胸腔镜技术治疗婴幼儿叶外型肺隔离症[J]. 中国微创外科杂志, 2021, 21(10): 923-926. LI Xiao, CAI Chun, SUN Yuling, et al. Single-port video-assisted thoracoscopic surgery for extralobar sequestration in infants [J]. Chinese Journal of Minimally Invasive Surgery, 2021, 21(10): 923-926.
[2] 贺锋, 陈天瑞, 周坤荣, 等. 单孔胸腔镜手术治疗肺隔离症的临床应用[J]. 中国微创外科杂志, 2022, 22(12): 962-965. HE Feng, CHEN Tianrui, ZHOU Kunrong, et al. Application of uni-portal video-assisted thoracoscopic surgery for the treatment of pulmonary sequestration [J]. Chinese Journal of Minimally Invasive Surgery, 2022, 22(12): 962-965.
[3] 武玉睿, 张士松, 刘红真, 等. 全胸腔镜下手术治疗小儿肺隔离症的疗效与安全性分析[J]. 临床小儿外科杂志, 2018, 17(5): 341-344. WU Yurui, ZHANG Shisong, LIU Hongzhen, et al. Experiences of complete thoracoscopy for pulmonary sequestration [J]. Journal of Clinical Pediatric Surgery, 2018, 17(5): 341-344.
[4] Robson VK, Shieh HF, Wilson JM, et al. Non-operative management of extralobar pulmonary sequestration: a safe alternative to resection? [J]. Pediatr Surg Int, 2020, 36(3): 325-331.
[5] 张娜, 曾骐, 陈诚豪, 等. 胸腔镜手术与开胸手术对不同类型小儿肺隔离症的适用性研究[J]. 临床小儿外科杂志, 2018, 17(5): 336-340. ZHANG Na, ZENG Qi, CHEN Chenghao, et al. Comparative study of outcomes for thoracoscopic versus open resection of pulmonary sequestration at a single pediatric institution: a report of 208 cases [J]. Journal of Clinical Pediatric Surgery, 2018, 17(5): 336-340.
[6] 赵生亮, 潘征夏, 李勇刚, 等. 胸腔镜与传统开胸手术治疗儿童先天性肺隔离症的临床疗效对比[J]. 第三军医大学学报, 2021, 43(2): 163-167. ZHAO Shengliang, PAN Zhengxia, LI Yonggang, et al. Clinical efficacy of thoracoscopy versus traditional thoracotomy in treatment of congenital pulmonary sequestration in children [J]. Acta Academiae Medicinae Militaris Tertiae, 2021, 43(2): 163-167.
[7] Wani SA, Mufti GN, Bhat NA, et al. Pulmonary sequestration: early diagnosis and management [J]. Case Rep Pediatr, 2015, 2015: 454860. doi: 10.1155/2015/454860.
[8] Lv L, Zhai Y, Zhao H, et al. Case report: an extremely rare case of double extralobar pulmonary sequestration with anomalous supplying arteries originating from the abdominal aorta in the left thoracic cavity [J]. Front Pediatr, 2022, 10: 926942. doi: 10.3389/fped.2022.926942.
[9] Lopoo JB, Goldstein RB, Lipshutz GS, et al. Fetal pulmonary sequestration: a favorable congenital lung lesion [J]. Obstet Gynecol, 1999, 94(4): 567-571.
[10] Shadmehr MB, Jamaati HR, Saidi B, et al. Extralobar sequestration in anterior mediastinum with pericardial agenesis [J]. Ann Thorac Surg, 2009, 88(1): 291-293.
[11] Huang D, Habuding A, Yuan M, et al. The clinical management of extralobar pulmonary sequestration in children [J]. Pediatr Pulmonol, 2021, 56(7): 2322-2327.
[12] Hilton TC, Keene WR, Blackshear JL. Intralobar pulmonary sequestration with nutrient systemic arterial flow from multiple coronary arteries [J]. Am Heart J, 1995, 129(4): 823-826.
[13] Skrabski R, Royo Y, Di Crosta I, et al. Extralobar pulmonary sequestration with an unusual venous drainage to the portal vein: preoperative diagnosis and excision by video-assisted thoracoscopy [J]. J Pediatr Surg, 2012, 47(10): e63-e65.
[14] Parikh PP, Tashiro J, Chahwala V, et al. Infant with bilateral pulmonary sequestrations with portal venous drainage excised by video-assisted thoracic surgery [J]. J Pediatr Surg, 2014, 49(8): 1332-1334.
[15] Borsellino A, Alberti D, Vavassori D, et al. Communicating bronchopulmonary foregut malformation involving a mixed sequestration/cystic adenomatoid malformation: a case report [J]. J Pediatr Surg, 2002, 37(11): E38. doi: 10.1053/jpsu.2002.36211.
[16] 刘清明, 钭金法, 叶菁菁, 等. 超声对儿童肺隔离症的诊断价值[J]. 中国医学影像学杂志, 2020, 28(7): 517-519.
[17] 杨宁, 夏平, 张佳, 等. 多层螺旋CT增强扫描对异常体动脉供血正常肺下叶与肺隔离症的鉴别诊断价值[J]. 徐州医科大学学报, 2023, 43(9): 681-684. YANG Ning, XIA Ping, ZHANG Jia, et al. Differential diagnostic value of MSCT enhanced scan in anomalous systemic artery to normal lower lobe and pulmonary sequestration [J]. Journal of Xuzhou Medical University, 2023, 43(9): 681-684.
[18] 林开武, 周作福, 施跃全, 等. MRI诊断胎儿先天性肺囊腺瘤样畸形及肺隔离症的应用价值[J]. 医学影像学杂志, 2020, 30(6): 1056-1058. LIN Kaiwu, ZHOU Zuofu, SHI Yuequan, et al. The value of MRI in prenatal diagnosis of congenital cystic adenomatoid malformation and bronchopulmonary sequestration [J]. Journal of Medical Imaging, 2020, 30(6): 1056-1058.
[19] 李林, 杨炼, 刘德翰, 等. 16例肺隔离症的介入治疗分析[J]. 中国临床医学影像杂志, 2020, 31(7): 482-485. LI Lin, YANG Lian, LIU Dehan, et al. Interventional therapy for pulmonary sequestration: a clinical analysis on 16 cases [J]. Journal of China Clinic Medical Imaging, 2020, 31(7): 482-485.
[20] Choudry R, Salvatore M, Hurie J, et al. Preoperative magnetic resonance imaging for intralobar pulmonary sequestration[J]. J Pediatr Surg, 2006, 41(4): 872-874.
[21] Laberge JM, Puligandla P, Flageole H. Asymptomatic congenital lung malformations [J]. Semin Pediatr Surg, 2005, 14(1): 16-33.
[22] Yoon HM, Kim EA, Chung SH, et al. Extralobar pulmonary sequestration in neonates: the natural course and predictive factors associated with spontaneous regression [J]. Eur Radiol, 2017, 27(6): 2489-2496.
[23] 苏芸, 武玉睿, 张晓伦, 等. 腔镜治疗小儿肺隔离症65例[J].中国微创外科杂志, 2021, 21(10): 899-903. SU Yun, WU Yurui, ZHANG Xiaolun, et al. Minimally invasive surgery for childrens pulmonary sequestration: report of 65 cases [J]. Chinese Journal of Minimally Invasive Surgery, 2021, 21(10): 899-903.
[24] Kasteler R, Lichtensteiger C, Schindera C, et al. Validation of questionnaire-reported chest wall abnormalities with a telephone interview in Swiss childhood cancer survivors [J]. BMC Cancer, 2021, 21(1): 787. doi: 10.1186/s12885-021-08425-z.
[25] Lam F, Lau CT, Yu MO, et al. Comparison of thoracoscopy vs. thoracotomy on musculoskeletal outcomes of children with congenital pulmonary airway malformation(CPAM)[J]. J Pediatr Surg, 2021, 56(10): 1732-1736.
[26] Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention [J]. Lancet, 2006, 367(9522): 1618-1625.
[1] 李东梅,边天帅,王晓华,张静,赵炎,孙素芬,牟鸿,许安廷. 儿童前庭神经炎的前庭诱发肌源性电位结果[J]. 山东大学学报 (医学版), 2026, 64(4): 38-43.
[2] 孙红林,管玉强,于培儒,李磊,杜庆霞,丁浩. 支架植入治疗儿童主动脉缩窄并高血压的可行性及近中期疗效[J]. 山东大学学报 (医学版), 2026, 64(4): 58-62.
[3] 况利,徐何雁. 从精准评估到整合干预:儿童青少年心理健康问题诊疗范式的革新与展望[J]. 山东大学学报 (医学版), 2026, 64(3): 10-16.
[4] 李芳华,刘娜,李晓宇,许殿花,王倩. 儿童青少年抑郁障碍患者服药依从性研究进展[J]. 山东大学学报 (医学版), 2026, 64(3): 24-34.
[5] 孙佳丽,王亮,王长凤,张杰,郭磊. Klippel-Trenaunay综合征儿童情绪与行为特征及其影响因素[J]. 山东大学学报 (医学版), 2026, 64(3): 78-82.
[6] 王倩,胡晓婧,王爱青,孙强,孟春燕,李芳华. 儿童青少年抑郁障碍患者非自杀性自伤文献的可视化分析[J]. 山东大学学报 (医学版), 2026, 64(3): 93-107.
[7] 王悦祺,宋东玉,李玉丽,谢昊,张月蓉. 儿童困难问题和亲社会行为在家庭弹性与祖辈隔代教养压力间的中介作用[J]. 山东大学学报 (医学版), 2026, 64(1): 57-64.
[8] 张政,王建伟,杨玉娟,张宇,宋西成. 哮喘儿童2008及2019年免疫球蛋白E变化及相关危险因素[J]. 山东大学学报 (医学版), 2025, 63(7): 32-36.
[9] 曹洛菲,王珊珊,王金荣,姜荷云,苗瑜,马光增. 哮喘发作期FeNO升高儿童肺功能舒张试验的特点分析[J]. 山东大学学报 (医学版), 2025, 63(6): 38-44.
[10] 陈绪军, 何国伟. 着力进一步推进动脉桥在我国冠心病冠脉旁路移植术中的应用[J]. 山东大学学报 (医学版), 2025, 63(5): 1-5.
[11] 莫绪明,王庆峰. 冠状动脉旁路移植术在儿童心血管疾病中的应用[J]. 山东大学学报 (医学版), 2025, 63(5): 40-46.
[12] 李玲,闫宇晗,孔清玉,王敏敏,赵海招,赵翠芬. 直立不耐受症状评分及儿茶酚胺与血管迷走性晕厥患儿情绪障碍的相关性[J]. 山东大学学报 (医学版), 2025, 63(5): 71-78.
[13] 王梦园,张春艳,于文文,寇琳娜,王世富. 2018—2021年山东省儿童与成人临床分离真菌的构成与主要菌种的体外抗真菌药物敏感性监测[J]. 山东大学学报 (医学版), 2025, 63(4): 83-93.
[14] 龚蓉,崔乃雪,陈恺悦,赵佳,单瑞洁,张训琪. 体感游戏在儿童癌症幸存者中的应用[J]. 山东大学学报 (医学版), 2025, 63(4): 94-99.
[15] 胡冰涛,张文灿,王崇怡,林翔宇,王凯斌,冯运泽,刘郴,徐万龙,李乐,司海朋. 基于加速康复外科理念的单孔分体内镜微创技术治疗腰椎管狭窄症的临床效果分析[J]. 山东大学学报 (医学版), 2025, 63(3): 1-7.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
版权所有 © 2018 《山东大学学报(医学版)》编辑部　
地址:山东大学科技期刊社（济南市历城区山大南路27号山东大学中心校区明德楼B座721室） 电话: 0531-88366918 E-mail: xbyxb@sdu.edu.cn
本系统由北京玛格泰克科技发展有限公司设计开发