Thoracoscopic Lobectomy for Congenital Lung Malformation in Children: Evolving Management Strategies and Their Impact in Outcomes

IF 2.4 2区医学 Q1 PEDIATRICS

Journal of pediatric surgery Pub Date : 2024-10-09 DOI:10.1016/j.jpedsurg.2024.161992

María López-Diaz , Indalecio Cano Novillo , Rocío Morante-Valverde , Araceli García Vázquez , Manuel Romero Layos , Alberto Galindo Izquierdo , Juan L. Antón-Pacheco

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引用次数: 0

Abstract

Background

The aim of this study was to determine the incidence of complications after thoracoscopic lobectomy in children according to a verified classification. Secondary aim was to evaluate the modifications made in our management protocol in order to decrease the rate of complications.

Methods

Retrospective study of pediatric patients in whom a lobectomy was performed for congenital lung malformation (CLM) in our institution between 2003 and 2021. The following data were collected: demographics, preoperative clinical symptoms, surgical technical details, and postoperative complications following the Clavien-Dindo (CD) classification. Main outcome measure was the presence of complications in the first month after lung lobectomy.

Results

90 lobectomies were performed in 89 patients. There were 46 girls (51.6%) and 43 boys with a median age of 12.4 months. Most patients (86.6%) remained asymptomatic until the surgical procedure. Postsurgical complications were detected in 26 cases (28.8%) and distributed into their respective category according to CD classification. In our experience, closure of the bronchial stump with interrupted suture or placement of an endoloop showed a statistically significant association with complications (p = 0.022 and p = 0.006 respectively). Moreover, patients in which a device combining sealing and section was used showed significantly fewer complications (p = 0.006).

Conclusions

Thoracoscopic lobectomy continues to be a challenging procedure. The CD grading system for postoperative complications has proved to be useful in this setting. Evolving surgical strategies and new miniaturized endosurgical devices have enabled a safer and quicker procedure with a positive impact in the development of complications.

Level of Evidence

III.

查看原文本刊更多论文

胸腔镜肺叶切除术治疗儿童先天性肺畸形：不断演变的管理策略及其对疗效的影响。

背景：本研究的目的是根据经过验证的分类确定儿童胸腔镜肺叶切除术后并发症的发生率。次要目的是评估我们为降低并发症发生率而对管理方案做出的修改：方法：对2003年至2021年间在我院因先天性肺畸形（CLM）而接受肺叶切除术的儿童患者进行回顾性研究。研究收集了以下数据：人口统计学、术前临床症状、手术技术细节以及按照克拉维恩-丁多（CD）分类的术后并发症。主要结果指标是肺叶切除术后第一个月出现并发症的情况：89名患者共进行了90例肺叶切除术。结果：89 名患者接受了 90 例肺叶切除术，其中 46 名女孩（51.6%），43 名男孩，中位年龄为 12.4 个月。大多数患者（86.6%）在手术前没有任何症状。有 26 例（28.8%）患者发现了手术后并发症，并根据 CD 分类法将其归入相应的类别。根据我们的经验，用间断缝合法缝合支气管残端或放置内环与并发症有显著的统计学关联（分别为 p = 0.022 和 p = 0.006）。此外，使用结合密封和切口的装置的患者并发症明显较少（p = 0.006）：结论：胸腔镜肺叶切除术仍然是一项具有挑战性的手术。结论：胸腔镜肺叶切除术仍然是一项具有挑战性的手术，术后并发症 CD 分级系统已被证明在这种情况下非常有用。不断发展的手术策略和新型微型化内外科设备使手术更加安全快捷，并对并发症的发生产生了积极影响：证据等级：III。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of pediatric surgery 医学-外科

CiteScore

1.10

自引率

12.50%

发文量

569

审稿时长

38 days

期刊介绍： The journal presents original contributions as well as a complete international abstracts section and other special departments to provide the most current source of information and references in pediatric surgery. The journal is based on the need to improve the surgical care of infants and children, not only through advances in physiology, pathology and surgical techniques, but also by attention to the unique emotional and physical needs of the young patient.