2. Methods
The study design was a retrospective review of the data from 24 symptomatic neonates with CCAM who underwent thoracoscopic or open resection at the Foshan Women and Children Hospital Affiliated to Southern Medical University, from April 2010 to April 2020. The pathological results of all cases were confirmed to be CCAM or CCAM combined with pulmonary sequestration (PS). The medical records were reviewed for preoperative, intraoperative and postoperative variables. Preoperative variables included gestational age at birth, sex, body weight, head circumference, location of the CCAM, lesion size, cystic adenomatoid malformation volume ratio (CVR)7, respiratory symptoms, associated anomalies and age at operation. Intraoperative variables included length od surgical incision, operation time and operative blood loss. Postoperative variables included postoperative ventilator days, duration of chest tube use, length of postoperative hospital stay and postoperative complications.
All cases were performed with preoperative CT or MRI scans and 3D reconstruction to better determine the range of the lesion (Fig. 1-A). Surgery was performed after the infection had adequately subsided. Central venous and bladder catheters were placed.
For the thoracoscopic resection procedure, general anesthesia, tracheal intubation and nonsingle lung ventilation were used. The patient was placed in a semiprone position with the affected side elevated to more easily expose the lesion. The first 5-mm trocar for thoracoscopy (5-mm 300, Olympus) was placed at the tip of the scapula. The second 5-mm trocar was inserted at the posterior axillary line, and the third 3-mm trocar was inserted at the interscapular region. Both trocars were parallel to the tip of the scapula. (Fig. 1-B) All trocars were sutured and fixed to prevent them from being pulled out. Carbon dioxide pressure was 3 mmHg to 5 mmHg. Thoracoscopic lobectomy or wedge resection was performed according to the size of the lesion (Fig. 1-C). An ultrasonically activated scalpel was used for wedge resection, and the lung wound was sutured with 4-0 absorbable thread. Hemo-locks were used to clip the main blood vessel and main bronchus during lobectomy. The chest tube was conventionally placed.
Statistical analyses were performed using SPSS Statistics (version 12.0.0.0). The Mann-Whitney U test was used to compare continuous variables with nonparametric variables. Fisher’s exact test and 2 × 2 contingency tables were used to compare categorical variables. Statistical significance was defined as a P value of less than .05. This study was approved by Medical Ethics Committee of Foshan Women and Children Hospital Affiliated to Southern Medical University (FSFY-MEC-2020-031).