Bao Pingqian,Huang Dongmei,Li Jie,et al.Clinical managements of extralobar pulmonary sequestration in children[J].Journal of Clinical Pediatric Surgery,2025,(09):868-871.[doi:10.3760/cma.j.cn101785-202405005-012]
儿童叶外型肺隔离症的临床治疗
- Title:
- Clinical managements of extralobar pulmonary sequestration in children
- 摘要:
- 目的 目前叶外型肺隔离症(extralobar pulmonary sequestration, ELS)的治疗方法仍存在分歧，本研究旨在阐明儿童叶外型肺隔离症的临床特点，为ELS的最佳临床治疗方案提供参考依据。方法 回顾性分析2013年1月至2020年4月在四川大学华西医院接受治疗的85例ELS患儿临床资料。根据ELS位置不同分为膈上组、膈肌组、膈下组，其中膈上组70例、膈肌组7例、膈下组8例。对各组手术年龄、手术时间、出血量、术后住院时间、病灶感染及术后并发症进行对比分析。结果 所有患儿均为产前超声检查发现。三组患儿手术年龄和术后住院时间差异无统计学意义(P>0.05)。所有膈上组、膈肌组ELS患儿均接受胸腔镜手术切除；8例膈下组患儿中，1例接受手术，其余7例采取保守观察。膈上组手术时间、出血量[(23.07±6.79)min、(3.18±4.94)mL]明显低于膈肌组[(40.14±9.92)min、(9.29±3.45)mL]和膈下组(70 min、30 mL)，差异均有统计学意义(P＜0.05)。三组均无一例留置胸引管；术后随访至少3个月，均无一例并发症发生。随访过程中，膈下组未手术患儿无一例出现病灶增大。结论 ELS存在感染和扭转的风险。因手术创伤小、围手术期风险低，胸腔镜手术可能是治疗膈上ELS的最佳方法，可发展为安全、快速康复的日间手术。膈肌ELS和膈下ELS则需要更大样本量、更多中心的数据研究，以得到更好的治疗方法。
- Abstract:
- Objective Currently there are still wide disagreements over the treatment options for extralobar pulmonary sequestration (ELS).This study aimed to clarify the characteristics of ELS in children and provide references for an optimal clinical treatment of ELS. Methods The relevant clinical data were retrospectively reviewed for 85 ELS children hospitalized at West China Hospital from January 2013 to April 2020.According to the different locations of ELS, they were assigned into three groups of upper-diaphragmatic (n=70), intra-diaphragmatic (n=7) and infra-diaphragmatic (n=8).Operative age, operative duration, blood loss, postoperative hospital stay, focal infection and postoperative complications were compared. Results All lesions were detected by prenatal ultrasound.No statistically significant differences existed in operative age and postoperative hospitalization stay among three groups (P>0.05).Upper/intra-diaphragmatic group underwent thoracoscopic resection.In infra-diaphragmatic group, surgery (n=1) and conservative observations (n=7) were performed.Operative duration and blood loss [(23.07±6.79), (3.18±4.94) mL]were significantly lower in upper-diaphragmatic group than those in intra-diaphragmatic group [(40.14±9.92), (9.29±3.45) mL]and infra-diaphragmatic group (70, 30 mL) (P < 0.05).None of three groups had thoracic drainage tubing.During a follow-up period of at least 3 months, no complications occurred.Non-operated children in infra-diaphragmatic group showed no symptoms or focal enlargement. Conclusions ELS carries the risks of infection and torsion.Due to its small mini-invasiveness and low perioperative risk, thoracoscopy is ideal for upper-diaphragmatic ELS and it may evolve into a safe and rapid-recovery day-case procedure.Intra/infra-diaphragmatic ELS requires a larger sample size and multiple center data to develop a better management approach.
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备注/Memo
收稿日期:2024-5-6。
基金项目:四川大学华西医院学科卓越发展1·3·5工程临床研究基金(2023HXFH039)
通讯作者:徐畅，Email: huaxixuchang@163.com