Liang Liang,Tan Zheng,Huang Ting,et al.Application of Da Vinci robot-assisted endoscopic technique for intradiaphragmatic pulmonary sequestration in children[J].Journal of Clinical Pediatric Surgery,2023,22(10):971-976.[doi:10.3760/cma.j.cn101785-202211024-013]
达芬奇机器人辅助腔镜手术在小儿膈肌内隔离肺治疗中的应用
- Title:
- Application of Da Vinci robot-assisted endoscopic technique for intradiaphragmatic pulmonary sequestration in children
- Keywords:
- Bronchopulmonary Sequestration; Robotic Surgical Procedures; Thoracoscopy; Treatment Outcome; Child
- 摘要:
- 目的 总结机器人辅助腔镜技术在小儿膈肌内隔离肺手术治疗中的应用经验。方法 回顾性分析2020年5月至2022年8月浙江大学医学院附属儿童医院收治的10例膈肌内隔离肺患儿临床资料,其中男4例、女6例,年龄6个月至5岁,中位年龄11个月,体重(10.97±3.07)kg。除2例为体检偶然发现外,其余8例均于产前胎儿超声检查过程中发现。10例隔离肺均位于左侧膈肌内,术前胸部增强CT检查均发现腹主动脉分支供血的膈肌内异常软组织,考虑为膈肌内隔离肺,收集所有患儿手术情况及治疗结果。结果 10例均经机器人辅助腔镜手术治愈。其中经胸手术8例,经腹手术2例,手术时间(91.50±31.18)min,术中均证实隔离肺位于膈肌内,予切开部分膈肌,结扎滋养血管后取出病灶,缝合膈肌组织。术后住院时间(4.30±1.06)d,均获随访(随访时间1~6个月),均生长发育良好。结论 手术切除是膈肌内隔离肺的主要治疗方法,经胸操作是首选,机器人手术系统用于儿童膈肌内隔离肺手术安全可行。
- Abstract:
- Objective To explore the application of robot-assisted endoscopic surgery for intradiaphragmatic pulmonary sequestration (IDPS) in children.Methods Clinical data were retrospectively reviewed for 10 IDPS children admitted into Children’s Hospital of Zhejiang University School of Medicine from May 2020 to August 2022.There were 4 boys and 6 girls with a median age of 11(6-60) month and an average weight of (10.97±3.07)(7.4-16.6) kg.Except for 2 cases accidentally spotted by physical examination,the other 8 cases were detected by prenatal fetal ultrasound.All lesions were located in left diaphragm.Enhanced chest computed tomography (CT) revealed abnormal soft tissue in diaphragm supplied by the branches of abdominal aorta.Results All procedures were successfully completed by robot-assisted endoscopic system.The routes were transthoracic (n=8) and transabdominal (n=2).The average operative duration was (91.50±31.18)(60-150) min.After a partial incision of diaphragm and a ligation of nutrient vessels,diaphragmatic tissue was sutured.No operative mortality occurred.The average postoperative hospitalization time was (4.30±1.06)(2-5) day.All of them recovered well during a follow-up period of (1-6) month.Conclusion The incidence of IDPS is low.Transthoracic resection is a major option.And robotic surgical system is both safe and feasible for IDPS in children.
参考文献/References:
[1] Montjoy C,Hadique S,Graeber G,et al.Intralobar bronchopulmonary sequestration in adults over age 50:case series and review[J].W V Med J,2012,108(5):8-13.
[2] Zhang N,Zeng Q,Chen CH,et al.Distribution,diagnosis and treatment of pulmonary sequestration:report of 208 cases[J].J Pediatr Surg,2019,54(7):1286-1292.DOI:10.1016/j.jpedsurg.2018.08.054.
[3] 张娜,曾骐,张旭.两种不同类型肺隔离症临床表现及诊治的回顾性研究[J].中华小儿外科杂志,2018,39(4):270-273.DOI:10.3760/cma.j.issn.0253-3006.2018.04.007.Zhang N,Zeng Q,Zhang X.Clinical features of two types of pulmonary sequestration:retrospective analysis of 208 cases[J].Chin J Pediatr Surg,2018,39(4):270-273.DOI:10.3760/cma.j.issn.0253-3006.2018.04.007.
[4] 严佳虞,曾骐,陈亚军,等.小儿腹腔内肺隔离症4例并文献复习[J].临床小儿外科杂志,2019,18(6):484-491.DOI:10.3969/j.issn.1671-6353.2019.06.010.Yan JY,Zeng Q,Chen YJ,et al.Pediatric intra-abdominal extralobar pulmonary sequestration:a report of 4 cases with a literature review[J].J Clin Ped Sur,2019,18(6):484-491.DOI:10.3969/j.issn.1671-6353.2019.06.010.
[5] 梁靓,谭征,黄婷,等.机器人辅助胸腔镜手术治疗小儿隔离肺20例[J].中华胸心血管外科杂志,2022,38(5):257-261.DOI:10.3760/cma.j.cn112434-20210111-00007.Liang L,Tan Z,Huang T,et al.Robotic assisted thoracoscopy for pulmonary sequestration in children:a report of 20 cases[J].Chin J Thorac Cardiovasc Surg,2022,38(5):257-261.DOI:10.3760/cma.j.cn112434-20210111-00007.
[6] Caulet T.Intradiaphragmatic estra-lobar pulmonary sequestration[J].Arch Anat Pathol (Paris),1962,10:150-151.
[7] Lee JH,Kim MJ.Intradiaphragmatic extralobar pulmonary sequestration in adult[J].J Cardiothorac Surg,2014,9(1):112.DOI:10.1186/1749-8090-9-112.
[8] Savic B,Birtel FJ,Tholen W,et al.Lung sequestration:report of seven cases and review of 540 published cases[J].Thorax,1979,34(1):96-101.DOI:10.1136/thx.34.1.96.
[9] Huang DM,Habuding A,Yuan M,et al.The clinical management of extralobar pulmonary sequestration in children[J].Pediatr Pulmonol,2021,56(7):2322-2327.DOI:10.1002/ppul.25433.
[10] Hong C,Yu G,Zhu XC,et al.Diagnosis and management of intradiaphragmatic extralobar pulmonary sequestration:a report of 11 cases[J].J Pediatr Surg,2015,50(8):1269-1272.DOI:10.1016/j.jpedsurg.2015.03.061.
[11] Nijagal A,Jelin E,Feldstein VA,et al.The diagnosis and management of intradiaphragmatic extralobar pulmonary sequestrations:a report of 4 cases[J].J Pediatr Surg,2012,47(8):1501-1505.DOI:10.1016/j.jpedsurg.2011.11.066.
[12] 俞钢,洪淳.胎儿隔肌内隔离肺的诊断和治疗[J].中华小儿外科杂志,2014,35(2):130-133.DOI:10.3760/cma.j.issn.0253-3006.2014.02.012.Yu G,Hong C.Diagnosis and treatment of fetal intradiaphragmatic extralobar pulmonary sequestrations[J].Chin J Pediatr Surg,2014,35(2):130-133.DOI:10.3760/cma.j.issn.0253-3006.2014.02.012.
[13] Joyeux L,Mejean N,Rousseau T,et al.Ectopic extralobar pulmonary sequestrations in children:interest of the laparoscopic approach[J].J Pediatr Surg,2010,45(11):2269-2273.DOI:10.1016/j.jpedsurg.2010.06.033.
[14] Shibuya S,Ogasawara Y,Izumi H,et al.A case of congenital diaphragmatic hernia with intradiaphragmatic pulmonary sequestration:case report and literature review[J].Pediatr Surg Int,2014,30(9):961-963.DOI:10.1007/s00383-014-3572-0.
[15] 冉旭东,廖建毅,徐永根,等.婴儿左侧膈疝合并膈肌内隔离肺1例[J].中华胸心血管外科杂志,2019,35(7):433.DOI:10.3760/cma.j.issn.1001-4497.2019.07.013.Ran XD,Liao JY,Xu YG,et al.Diagnosis and management of infant with left diaphragmatic hernia couple with intradiaphragmatic extralobar pulmonary sequestrations:one case report[J].Chin J Thorac Cardiovasc Surg,2019,35(7):433.DOI:10.3760/cma.j.issn.1001-4497.2019.07.013.
[16] Meier AH,Eggli KD,Cilley RE.Intradiaphragmatic extralobar sequestration-a rare pulmonary anomaly[J].J Pediatr Surg,2009,44(12):e27-e29.DOI:10.1016/j.jpedsurg.2009.09.026.
[17] 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.DOI:10.1007/s00383-019-04590-2.
[18] Yang L,Yang G.Extralobar pulmonary sequestration with a complication of torsion:a case report and literature review[J].Medicine (Baltimore),2020,99(29):e21104.DOI:10.1097/MD.0000000000021104.
[19] Kampolis CF,Damaskos C,Loukeri AA,et al.Primary hemangiopericytoma arising in extralobar pulmonary sequestration:a coincidence or two rare disorders?[J].In Vivo,2019,33(6):2141-2145.DOI:10.21873/invivo.11715.
[20] 李建华.小儿肺隔离症的手术适应证、手术时机及术前干预[J].临床小儿外科杂志,2018,17(5):328-331.DOI:10.3969/j.issn.1671-6353.2018.05.003.Li JH.Surgical indications,surgical timing and preoperative interventions for pulmonary sequestration in children[J].J Clin Ped Sur,2018,17(5):328-331.DOI:10.3969/j.issn.1671-6353.2018.05.003.
[21] Escobar MA Jr,Acierno SP.Laparoscopic resection of an intradiaphragmatic pulmonary sequestration:a case report and review of the literature[J].J Pediatr Surg,2012,47(11):2129-2133.DOI:10.1016/j.jpedsurg.2012.09.036.
[22] 何玉琴,张若仙,江魁明.膈下左肾上腺区肺隔离症一例[J].中华消化病与影像杂志(电子版),2017,7(6):280-281.DOI:10.3877/cma.j.issn.2095-2015.2017.06.011.He YQ,Zhang RX,Jiang KM.Pulmonary sequestration in subphrenic left adrenal region:one case report[J].Chinese Journal of Digestion and Medical Imageology (Electronic Edition),2017,7(6):280-281.DOI:10.3877/cma.j.issn.2095-2015.2017.06.011.
[23] McAteer J,Stephenson J,Ricca R,et al.Intradiaphragmatic pulmonary sequestration:advantages of the thoracoscopic approach[J].J Pediatr Surg,2012,47(8):1607-1610.DOI:10.1016/j.jpedsurg.2012.05.010.
[24] Yamada K,Muto M,Onishi S,et al.Thoracoscopic repair of neonatal left diaphragmatic hernia with sac combined with both extralobar pulmonary sequestration and congenital pulmonary airway malformation[J].Asian J Endosc Surg,2023,16(1):127-130.DOI:10.1111/ases.13120.
[25] 谭征,俞建根,梁靓,等.达芬奇机器人辅助腔镜技术在小儿胸科手术中的应用[J].中华小儿外科杂志,2022,43(3):206-209.DOI:10.3760/cma.j.cn421158-20201126-00719.Tan Z,Yu JG,Liang L,et al.Application of Da Vinci robot-assisted endoscopy during pediatric thoracic surgery[J].Chin J Pediatr Surg,2022,43(3):206-209.DOI:10.3760/cma.j.cn421158-20201126-00719.
[26] 章坚,俞建根,谭征,等.机器人辅助胸腔镜技术在儿童纵隔肿瘤切除术中的应用[J].中华小儿外科杂志,2022,43(8):709-713.DOI:10.3760/cma.j.cn421158-20210410-00174.Zhang J,Yu JG,Tan Z,et al.Application of robot-assisted thoracoscopy for mediastinal tumors in children[J].Chin J Pediatr Surg,2022,43(8):709-713.DOI:10.3760/cma.j.cn421158-20210410-00174.
[27] 谭征,俞建根,梁靓,等.机器人辅助胸腔镜技术治疗小儿先天性肺部疾病的单中心研究[J].临床小儿外科杂志,2021,20(8):708-711.DOI:10.3969/j.issn.1671-6353.2021.08.002.Tan Z,Yu JG,Liang L,et al.Robot-assisted thoracoscopy for congenital pulmonary diseases in children[J].J Clin Ped Sur,2021,20(8):708-711.DOI:10.3969/j.issn.1671-6353.2021.08.002.
相似文献/References:
[1]梁建华,刘威,汪风华,等.小儿肺隔离症20例临床分析[J].临床小儿外科杂志,2016,15(04):386.
[2]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应性研究[J].临床小儿外科杂志,2018,17(05):336.
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(10):336.
[3]王允金,周朝明,崔旭,等.不同手术方式治疗小儿肺隔离症的比较研究[J].临床小儿外科杂志,2018,17(05):345.
Wang Yunjin,Zhou Chaoming,Cui Xu,et al.Clinical efficacies of different surgical approaches for pediatric pulmonary sequestration.[J].Journal of Clinical Pediatric Surgery,2018,17(10):345.
[4]严佳虞,曾骐,陈亚军,等.小儿腹腔内肺隔离症4例并文献复习[J].临床小儿外科杂志,2019,18(06):484.[doi:10.3969/j.issn.1671-6353.2019.06.010]
Yan Jiayu,Zeng Qi,Chen Yajun,et al.Pediatric intra-abdominal extralobar pulmonary sequestration: a case series and literature review[J].Journal of Clinical Pediatric Surgery,2019,18(10):484.[doi:10.3969/j.issn.1671-6353.2019.06.010]
[5]张书豪,高志刚,钭金法,等.机器人手术在小儿外科领域的应用现状[J].临床小儿外科杂志,2021,20(08):701.[doi:10.12260/lcxewkzz.2021.08.001]
Zhang Shuhao,Gao Zhigang,Tou Jinfa,et al.Current applications of robotic procedures in pediatric surgery[J].Journal of Clinical Pediatric Surgery,2021,20(10):701.[doi:10.12260/lcxewkzz.2021.08.001]
[6]谭征,俞建根,梁靓,等.机器人辅助胸腔镜技术治疗小儿先天性肺部疾病的单中心研究[J].临床小儿外科杂志,2021,20(08):708.[doi:10.12260/lcxewkzz.2021.08.002]
Tan Zheng,Yu Jiangeng,Liang Liang,et al.Robot-assisted thoracoscopy in the treatment of congenital pulmonary diseases in children[J].Journal of Clinical Pediatric Surgery,2021,20(10):708.[doi:10.12260/lcxewkzz.2021.08.002]
[7]赵扬,周辉霞,马立飞,等.机器人辅助腹腔镜技术应用于儿童肾上腺肿物切除术的初步经验[J].临床小儿外科杂志,2021,20(08):712.[doi:10.12260/lcxewkzz.2021.08.003]
Zhao Yang,Zhou Huixia,Ma Lifei,et al.Preliminary experience of robot-assisted laparoscopic adrenal mass resection in children[J].Journal of Clinical Pediatric Surgery,2021,20(10):712.[doi:10.12260/lcxewkzz.2021.08.003]
[8]章跃滨,陈青江,蔡多特,等.机器人手术系统辅助儿童脾切除术三例并文献复习[J].临床小儿外科杂志,2021,20(08):718.[doi:10.12260/lcxewkzz.2021.08.004]
Zhang Yuebin,Chen Qingjiang,Cai Duote,et al.Robot-assisted laparoscopic splenectomy in children: a report of 3 cases with review of the literature[J].Journal of Clinical Pediatric Surgery,2021,20(10):718.[doi:10.12260/lcxewkzz.2021.08.004]
[9]马洪,汤显能,郭跃明.机器人手术系统辅助经皮原位固定术治疗儿童股骨头骨骺滑脱的比较研究[J].临床小儿外科杂志,2021,20(08):724.[doi:10.12260/lcxewkzz.2021.08.005]
Ma Hong,Tang Xianneng,Guo Yueming.Comparative study of percutaneous in stu fixation of slipped capital femoral epiphysis assisted by surgical robotic system[J].Journal of Clinical Pediatric Surgery,2021,20(10):724.[doi:10.12260/lcxewkzz.2021.08.005]
[10]陈艳,周立军,汪亚平,等.机器人辅助腹腔镜技术治疗儿童肾上腺嗜铬细胞瘤一例并文献复习[J].临床小儿外科杂志,2021,20(08):731.[doi:10.12260/lcxewkzz.2021.08.006]
Chen Yan,Zhou Lijun,Wang Yaping,et al.Robot-assisted laparoscopic adrenalectomy for children with adrenal pheochromocytoma: one case report with a literature review[J].Journal of Clinical Pediatric Surgery,2021,20(10):731.[doi:10.12260/lcxewkzz.2021.08.006]
备注/Memo
收稿日期:2022-11-12。
通讯作者:谭征,Email:tanzheng@zju.edu.cn