Ten years of rapid development of pediatric thoracic surgery in China

摘要

China's pediatric surgery is a specialty first established in 1954 by Prof. Jinzhe Zhang, an academician of the Chinese Academy of Engineering. During the same period, several professors (most notably Anquan Ma, Yaxiong She, Zanyao Wang, and Erchang Tong) successively established pediatric surgery specialties1 in Shanghai and Wuhan, as well as in Shenyang, Chengdu, Chongqing, and Guangzhou. Initially, pediatric surgery primarily focused on treatment of emergencies, such as trauma, burns, surgical infection, and acute abdomen. Subsequently, as economic conditions improved, emergency cases decreased; in contrast, cases of congenital malformation increased annually as a focus of pediatric surgery. With the establishment of pediatric surgery subspecialties nationwide, as well as continuous enhancement in the diagnosis and treatment of pediatric surgery, patients’ families have begun to expect more professional diagnosis and treatment of different local and systemic conditions in pediatric surgery. Beginning from general pediatric surgery, subspecialties of pediatric surgery have been gradually established; these include orthopedics, neonatal surgery, cardiothoracic surgery, oncological surgery, and plastic surgery. Beijing Children's Hospital affiliated to Capital Medical University established subspecialties of pediatric surgery in 1972, in the manner advocated by Dr. Jinzhe Zhang; these included thoracic surgery, which was then headed by chief physician Feng Xue and focused on treating pediatric patients with thoracic diseases. At its inception, the department had four ward beds and provided services for infectious diseases, such as empyema, lung abscess, and tuberculosis; it then gradually expanded its services to include diagnosis and treatment of mediastinal tumor, pectus excavatum, pectus carinatum, hiatal hernia, diaphragmatic hernia, congenital pulmonary cyst, as well as other diseases. In the late 1980s, Professors Tingze Hu and Wenying Liu also established the subspecialty of pediatric thoracic surgery at West China Hospital (Sichuan University), and began to conduct some basic investigations regarding infectious diseases and pectus excavatum.2 At that time, in most other children's hospitals in China, the diagnosis and treatment of pediatric thoracic diseases was performed by the cardiothoracic surgery department, or by the general surgery department. A small number of pediatric thoracic diseases were diagnosed and treated by the thoracic surgery department in adult general hospitals. (1) High surgical risk and a variety of complications Pediatric thoracic surgery is not a scaled-down version of adult thoracic surgery. First, different disease spectra are involved in each type of surgery. Adults may exhibit lung cancer or esophageal cancer, which is rarely encountered in children. Malignant pulmonary tumors in children also differ from those in adults (e.g., the uncommon pleuropulmonary blastoma). Pediatric thoracic diseases primarily comprise congenital malformations of many types, some of which are unique to pediatric patients but exhibit relatively low incidence rates. Second, surgical procedures and postoperative management performed for adult patients cannot be directly applied for use in pediatric patients. For example, early pediatric thoracotomy was performed using the approach for adult thoracotomy: partial ribs were excised, and intercostal muscles were sutured after surgery to close the thoracic cavity, without the use of an indwelling closed thoracic drainage tube. Because of the thin nature of the thoracic wall, pediatric patients often died of tension pneumothorax after surgery. Moreover, in the early period, anesthetic and life-support techniques were relatively immature and the single-lung ventilation technique was unavailable; thus, it was difficult to control respiration during surgery, and the surgical field could not be clearly exposed. In this context, postoperative care and perioperative management