南方医科大学学报

南方医科大学学报 ›› 2023, Vol. 43 ›› Issue (4): 649-653.doi: 10.12122/j.issn.1673-4254.2023.04.20

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逆向肺部分切除术：小儿肺囊肿的外科处理新方法

杨利博，周海深，欧阳学军，张福伟，冯 靖，张家庆   

  1. 南方医科大学珠江医院胸外科，广东 广州 510280
  • 出版日期:2023-04-20 发布日期:2023-05-16

Reverse partial pulmonary resection: a new surgical approach for pediatric pulmonary cysts

YANG Libo, ZHOU Haishen, OUYANG Xuejun, ZHANG Fuwei, FENG Jing, ZHANG Jiaqing   

  1. Department of Thoracic Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China
  • Online:2023-04-20 Published:2023-05-16

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摘要： 目的 明确逆向肺部分切除术治疗小儿肺囊肿合并肺脓肿或脓胸的安全性和有效性。方法 回顾性分析2020年6月~2021年6月于我院接受逆向肺部分切除术的复杂性肺囊肿患儿的临床资料。手术体位选择侧卧位，切口选择病灶中心位置肋间，长度3~5 cm，切口近可能接近病灶，以免不必要的分离。进入胸腔后于病灶中心处切开脏层胸膜，尽快清除病灶内的液体或坏死物质，同时嘱麻醉医师气管内吸痰，防止坏死物质进入对侧气管。清除病灶内的坏死物质并分离疱性肺组织至肺门侧健康肺组织处，将病灶内条索样组织近端先用4号丝线双重结扎，远端离断，再用4-0 Prolene线连续缝合加固近端，条索样组织为支配病灶内的肺血管和支气管。后使用能量器械或切割闭合器分离病变肺与健康肺组织平面。清除肺与壁层胸膜之间坏死物质，彻底冲洗胸腔，膨肺检查漏气处，对严重漏气肺组织或裸露的微小支气管破口采用5-0 Prolene线进行缝合加固。无明显脓性物质的肺与胸壁粘连处，无需分离。结果 共入组16例患儿，年龄3 d~2岁，其中3例单纯性肺囊肿，11例肺囊肿合并肺脓肿或脓胸，1例肺囊肿合并张力性气胸和左上肺支气管缺损，1例肺大疱合并脑组织异位。入组患者手术均采用逆向肺部分切除术，术程顺利，手术平均时间129 min，平均住院时间11 d，拔除引流管平均时间7 d。术后各患儿均恢复良好，其中11例合并轻度漏气，均无严重并发症发生。术后随访胸部CT无病灶残留或感染复发。结论 逆向肺部分切除术这一新术式在复杂性小儿肺囊肿或合并感染者的治疗中安全可行，初步判断该技术具有创伤小、操作简单等优势。

关键词: 逆向肺部分切除；肺囊肿；肺脓肿；脓胸

Abstract: Objective To evaluate the safety and efficacy of reverse partial lung resection for treatment of pediatric pulmonary cysts combined with lung abscesses or thoracic abscess. Methods We retrospectively analyzed the clinical data of children undergoing reverse partial lung resection for complex pulmonary cysts in our hospital between June, 2020 and June, 2021. During the surgery, the patients lay in a lateral position, and a 3-5 cm intercostal incision was made at the center of the lesion, through which the pleura was incised and the fluid or necrotic tissues were removed. The anesthesiologist was instructed to aspirate the sputum in the trachea to prevent entry of the necrotic tissues in the trachea. The cystic lung tissue was separated till reaching normal lung tissue on the hilar side. The proximal end of the striated tissue in the lesion was first double ligated with No.4 silk thread, the distal end was disconnected, and the proximal end was reinforced with continuous sutures with 4-0 Prolene thread. The compromised lung tissues were separated, and the thoracic cavity was thoroughly flushed followed by pulmonary inflation, air leakage management and incision suture. Results Sixteen children aged from 3 day to 2 years underwent the surgery, including 3 with simple pulmonary cysts, 11 with pulmonary cysts combined with pulmonary or thoracic abscess, 1 with pulmonary cysts combined with tension pneumothorax and left upper lung bronchial defect, and 1 with pulmonary herpes combined with brain tissue heterotaxy. All the operations were completed smoothly, with a mean operation time of 129 min, an mean hospital stay of 11 days, and a mean drainage removal time of 7 days. All the children recovered well after the operation, and 11 of them had mild air leakage. None of the children had serious complications or residual lesions or experienced recurrence of infection after the operation. Conclusion Reverse partial lung resection is safe and less invasive for treatment of complex pediatric pulmonary cysts complicated by infections.

Key words: reverse pulmonary resection; pulmonary cyst; pulmonary abscess; empyema