Thoracoscopic Lobectomy for Congenital Cystic Lung Disease in Infants

Background: Congenital cystic lung disease is a congenital disease with abnormal development of the trachea, pulmonary parenchyma and pulmonary vessels. Congenital cystic adenomatoid malformation and pulmonary sequestration are the two main types. With the development of endoscopic technology, congenital pulmonary dysplasia has been alleviated in an increasing number of infants through thoracoscopic surgery. However, the timing of the operation is controversial.Methods: Seventy-two infants with congenital cystic lung disease who underwent thoracoscopic lobectomy from March 2017 to April 2020 were selected as subjects. The data were summarized and analysed, including preoperative complications, operative situation, postoperative recovery, postoperative hospital stay time, etc. All children were followed regularly.Results: Seventy-two patients were aged 3 to 7 months, with an average age of 5.40±2.02 months: 44 were male, and 28 were female, with an average weight of 6.95±1.96 kg. Preoperative condition: 48 patients were observed and operated on when they were between 5 and 7 months old. Twenty-four patients were diagnosed with pneumonia, and thoracoscopic surgery was performed after anti-infective therapy. All children were diagnosed with congenital cystic pulmonary disease with a CT scan before the operation. Postoperative pathological diagnosis showed 50 cases of congenital cystic adenomatoid malformation, 16 cases of intralobar pulmonary sequestration, and 6 cases of both congenital cystic adenomatoid malformation and intralobar pulmonary sequestration. Anaesthesia was performed by artificial pneumothorax or bronchial occlusion. The average operative time was 92.17±19.65 min, and the average length of postoperative ventilator assistance was 28.18±11.01 hours. Complications: 3 cases of pneumothorax after the operation and 5 cases of atelectasis, and the incidence of pneumonia was 33%. No bleeding, bronchial pleural fistula or other serious complications were observed. All children were followed for 3 months to 2 years. The growth and development of all the children were not different from those of normal children.Conclusions: In this study, preoperative pneumonia accounted for 23.6% of children. Thoracoscopic lobectomy was effective and feasible for children with congenital cystic lung disease from 3 to 7 months of age.