小児肺疾患に対する完全胸腔鏡下肺葉切除術の成績と安全性の検討

Outcomes and safety of complete thoracoscopic lobectomy for pediatric lung disease

◆要旨：当科で2009年から2022年までに完全胸腔鏡下肺葉切除術を施行した41例を対象に患者背景と手術成績を検討した．男児21例，女児20例，手術時月齢15か月（中央値，以下同様），手術時体重9.5kgであった．気管支閉鎖症18例，肺葉内肺分画症9例，先天性囊胞性腺腫様奇形（congenital cystic adenomatoid malformation：CCAM）6例，その他8例であった．右上葉切除6例，右中葉切除1例，右下葉切除17例，左上葉切除2例，左下葉切除15例であった．手術時間279分，出血量24mL，ドレーン抜去まで3日，術後在院日数は6日であった．全例で開胸移行は認めなかった．6例で術後合併症を認め，うち2例は気管支断端瘻で再手術を要した．術後フォロー期間は33か月であった．当科術式の成績と要点から小児における完全胸腔鏡下肺葉切除術の実行可能性について検討した．

　［Introduction］Complete thoracoscopic lobectomy（CTL） is considered the first-line procedure for pediatric lung disease in our department, given its less invasive nature, better long-term cosmetic outcomes, and reduced risk of thoracic deformity. This study aims to illustrate the outcomes and key points of CTL in our department and to evaluate its feasibility for treating pediatric lung disease.［Methods］We retrospectively identified all patients who underwent CTL between 2009 and 2022 in our department. Patient demographics and surgical outcomes were reviewed.［Results］A total of 41 patients underwent CTL（6 right upper lobectomies, 1 right middle lobectomy, 17 right lower lobectomies, 2 left upper lobectomies, and 15 left lower lobectomies）. No cases required conversion to thoracotomy. The median age and weight at the time of surgery were 15 months and 9.5 kg, respectively. The primary diagnoses were bronchiectasis in 18 patients, intralobar pulmonary sequestration in 9 patients, congenital cystic adenomatoid malformation in 6 patients, and other lung diseases in 8 patients. The median surgical time was 279 min, with a median blood loss of 24 mL. The median time to drain removal was 3 days, and the median postoperative length of stay was 6 days. Perioperative complications occurred in 6 cases, including 2 instances of bronchopleural fistula which required thoracoscopic reoperation. Postoperative pulmonary function tests were performed in 10 patients, with a median％VC of 93.7％and a median FEV_1.0％of 81.4％. The median follow-up period was 33 months.［Conclusion］CTL for pediatric lung disease was considered safe and feasible.