Precise Thoracoscopic Pneumonectomy Using Fluorescence Imaging After Aerosolized Indocyanine Green Inhalation: A Novel Strategy for Treating Congenital Pulmonary Airway Malformation

IF 2.4 2区医学 Q1 PEDIATRICS Journal of pediatric surgery Pub Date : 2024-11-12 DOI:10.1016/j.jpedsurg.2024.162063

Tianqi Zhu , Yanan Li , Jiaxin Zhang , Xiaofeng Xiong , Ye Yin , Didi Zhuansun , Ying He , Jiexiong Feng

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Abstract

Background

Lobectomy resection is the standard treatment for patients with congenital pulmonary airway malformation (CPAM). However, accurate localization of CPAM lesions and avoiding excessive resection of normal lung tissue are one of the critical issues that can impact postoperative pulmonary function. Indocyanine green (ICG) can be adopted in lung preservation surgery, to minimize damage to normal lung tissue during thoracoscopic pneumonectomy.

Objective

To demonstrate the potential benefits of aerosol inhalation of ICG followed by thoracoscopic precision pneumonectomy for the treatment of CPAM.

Methods

From January 2023 to March 2024, we prospectively collected clinical data from 34 pediatric patients diagnosed with CPAM and treated with thoracoscopic surgery. Patients inhaled ICG aerosol solution (0.5 mg/kg) approximately 30–60 min before the operation. During surgery, fluorescence thoracoscopy was used to clearly locate the lesion boundaries and achieve precise resection.

Results

All patients successfully underwent thoracoscopic precise resection of CPAM lesions without conversion to open surgery. The mean operation time was 100.3 ± 24.6 min, and the mean intraoperative blood loss was 30.5 ± 25.6 mL. The mean total length of hospital stay (tLOS) was 6.6 ± 3.2 days. No adverse reactions to ICG were observed. Postoperative complications included one case of pneumothorax (5.9 %) and three cases of subcutaneous emphysema (17.6 %), all of which resolved without special intervention. Follow-up CT scans and pulmonary function tests conducted 6 months post-surgery demonstrated the absence of residual or recurrent lesions and notable enhancement in pulmonary function.

Conclusion

Preliminary results indicated that the treatment of CPAM with aerosolized ICG followed by thoracoscopic precise pneumonectomy is safe and feasible.

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气溶胶吲哚菁绿吸入后利用荧光成像进行精确胸腔镜肺切除术：治疗先天性肺气道畸形的新策略。

背景：肺叶切除术是先天性肺气道畸形（CPAM）患者的标准治疗方法。然而，准确定位 CPAM 病灶和避免过度切除正常肺组织是影响术后肺功能的关键问题之一。在保肺手术中可采用吲哚菁绿（ICG），以减少胸腔镜肺切除术对正常肺组织的损伤：证明气溶胶吸入 ICG 后进行胸腔镜精确肺切除术治疗 CPAM 的潜在益处：从 2023 年 1 月到 2024 年 3 月，我们前瞻性地收集了 34 名被诊断为 CPAM 并接受胸腔镜手术治疗的儿科患者的临床数据。患者在手术前约 30-60 分钟吸入 ICG 气溶胶溶液（0.5 mg/kg）。手术过程中使用荧光胸腔镜清晰定位病灶边界，实现精确切除：结果：所有患者均成功接受了胸腔镜下 CPAM 病灶精确切除术，未转为开放手术。平均手术时间为（100.3±24.6）分钟，术中平均失血量为（30.5±25.6）毫升。平均住院总时间（tLOS）为 6.6 ± 3.2 天。未发现 ICG 不良反应。术后并发症包括一例气胸（5.9%）和三例皮下气肿（17.6%），所有并发症均在未采取特殊干预措施的情况下得到缓解。术后 6 个月的随访 CT 扫描和肺功能测试显示，没有残留或复发病灶，肺功能也明显改善：初步结果表明，用气雾化 ICG 治疗 CPAM，然后进行胸腔镜精确肺切除术是安全可行的。

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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.