背景:由于复杂的解剖变异,节段间平面(ISP)的识别是先天性肺气道畸形(CPAM)患儿节段切除术中的关键步骤。然而,在这方面,专门针对婴儿的文献非常有限。在这项研究中,我们比较了静脉吲哚菁绿(ICG)引导的近红外荧光(NIRF)成像方法与改良的充气-放气方法的围手术期特点,并总结了我们的经验.
方法:从2021年6月至2022年11月,回顾性分析了83例CPAM患者的数据,这些患者接受了电视胸腔镜手术的节段切除术。28例患者接受ICG引导NIRF方法,56例患者接受了改良的充气-放气方法,比较了患者的特点和临床结局.
结果:患者的中位年龄为4.99个月(4.99±1.51),平均体重为7.54kg(7.54±1.99)。两种方法都能准确识别ISP。ICG组清晰显示ISP所需的时间短于改良的通货膨胀-通货紧缩组(0.18±0.08vs.6.49±1.67分钟;P<0.001),和手术持续时间(61.32±14.28vs.ICG组的88.18±8.03分钟;P<0.001)也明显缩短。两组在胸管引流长度方面表现出差异(1.75±1.24vs.2.36±1.54天;P=0.072)和住院时间(4.61±1.75vs.5.20±3.07天;P=0.078),然而,差异无统计学意义。两组在失血量和术后并发症方面无统计学差异。在术后1年以上的随访中,所有患者均恢复良好,无复发.
结论:根据我们的经验,ICG引导的NIRF方法是安全和可行的婴儿胸腔镜节段切除术,与改进的充气放气方法相比,它可以快速显示ISP并缩短手术时间。
BACKGROUND: The identification of the intersegmental plane (ISP) is a crucial step in segmentectomy for children with congenital pulmonary airway malformation (CPAM) due to complex anatomical variations. However, there is very limited literature available on this aspect specifically for infant. In this study, we compared the intravenous indocyanine green (ICG)-guided near-infrared fluorescence (NIRF) imaging method with the modified inflation-deflation method in terms of their perioperative characteristics and summarized our experience.
METHODS: From June 2021 to November 2022, the data of 83 patients with CPAM who underwent segmentectomy by video-assisted thoracoscopic surgery were retrospectively reviewed. Twenty-eight patients underwent ICG-guided NIRF method, and 56 patients underwent the modified inflation-deflation method, characteristics and clinical outcomes were compared.
RESULTS: The median age of the patients was 4.99 months (4.99 ± 1.51) with a mean body weight of 7.54 kg (7.54 ± 1.99). Both methods could accurately identify the ISP. The time taken to clearly display the ISP was shorter in ICG group than in the modified inflation-deflation group (0.18 ± 0.08 vs. 6.49 ± 1.67 min; P < 0.001), and the surgical duration (61.32 ± 14.28 vs. 88.18 ± 8.03 min; P < 0.001) were significantly shorter in the ICG group too. The two groups exhibited differences in the length of chest tube drainage (1.75 ± 1.24 vs. 2.36 ± 1.54 days; P = 0.072) and the length of hospital stay (4.61 ± 1.75 vs. 5.20 ± 3.07 days; P = 0.078), however, the differences were not statistically significant. There were no significant differences between the two groups in the blood lost and postoperative complications. At a follow-up of more than 1 year after operation, all patients had recovered well without recurrence.
CONCLUSIONS: According to our experience, the ICG-guided NIRF method was safe and feasible for infants during thoracoscopic segmentectomy, it can quickly display the ISP and shorten the surgical duration compared with the modified inflation-deflation method.