摘要目的:评估经肺门入路胸腔镜肺叶切除术治疗儿童先天性肺畸形伴叶裂发育不全的安全性和有效性。方法:纳入2014年1月至2020年12月在四川大学华西医院小儿外科行经肺门入路胸腔镜肺叶切除术的先天性肺畸形患儿共550例，根据叶裂解剖分型将患儿分为叶裂发育不全组(IF组)和叶裂发育完全组(CF组)，IF组共152例患儿，CF组共398例患儿。对两组患儿术中、术后的临床资料和手术结果进行比较与分析。连续参数数据采用 t检验，连续非参数数据采用Wilcoxon检验，非连续数据采用 χ2检验或Fisher确切概率法。 结果:单因素分析显示两组患儿术中出血( P＝0.02)、手术时间( P＝0.01)、胸腔引流管放置时间( P<0.01)和术后住院时间( P＝0.03)差异存在统计学意义。两组患儿均无术中中转开放手术；IF组有7例患儿术后出现漏气，均在安放或延长留置胸腔闭式引流管后自愈；两组均无支气管胸膜瘘、大出血、重症肺炎等严重术后并发症发生。 结论:叶裂发育不全会增加儿童先天性肺畸形胸腔镜肺叶切除的手术难度，经肺门入路的方式可安全而有效地降低这类患儿的中转开放率和术后并发症发生率。

abstractsObjective:To evaluate the safety and efficacy of thoracoscopic lobectomy via a hilar approach for congenital pulmonary malformations with lobar fissure hypoplasia in children.Methods:From January 2014 to December 2020, 550 CLM children undergoing thoracoscopic lobectomy were divided into two groups of incomplete fissure (IF, n=152) and complete fissure (CF, n=398). Clinical data and surgical outcomes of two groups were compared.For continuous parametric data, t test was employed; for continuous non-parametric data, Wilcoxon test; discontinuous data, 2 test or Fisher's exact probability method.Results:Univariate analysis revealed inter-group statistical differences in intraoperative volume of blood loss ( P=0.02), operative duration ( P=0.01), placement time of thoracic drainage tube ( P<0.01) and postoperative hospital stay ( P=0.03). Seven patients in IF group experienced postoperative air leakage.All of them were cured after replacing or extending placing time of chest tube.None of them experienced bronchopleural fistula, postoperative severe pneumonia or major hemorrhage. Conclusions:Although incomplete fissure increases the difficulty of thoracoscopic lobectomy, hilum-first technique may safely and effectively lower the risk of postoperative complications and reduce the rate of conversion into thoracotomy in CLM children.