Surgical Treatment For Bronchogenic Cysts And Congenital Esophageal Cysts

Objective:To discuss the diagnosis and evaluate the effect of surgical methods of bronchogenic cysts and congenital esophageal cysts.Methods:We retrospectively analysed the clinical data of133cases of bronchogenic cysts and22cases of congenital esophageal cysts who had been undertook surgery in our hospital and been confirmedly diagnosed by pathology. We review the clinical manifestations, imaging characteristics, clinical diagnosis, the methods and effect of surgical treatments and other factors. All statistical analysis were performed using SPSS13.0, count data using chi-square test; measurement data using independent sample t test. P<0.05indicated a statistically significant difference between the two sets of comparison datas.Results:Of133cases of bronchogenic cysts,63male,70female, with an average age of47years, there were clinical symptoms in74(55.6%) cases and the most common symptoms was cough. There were83cases of bronchogenic cysts in the mediastinum,15cases in the anterior mediastinum,30cases in the mediastinum and38cases in the posterior mediastinum, of which were five cases of intramural esophageal bronchogenic cysts (to be discussed with esophageal cysts). There were45cases of intrapulmonary bronchogenic cysts,21cases in the left side,24cases in the right side, including15cases in upper lobe,2cases in the middle lobe and29cases in lower lobe.There were five cases of bronchogenic cysts located in the neck. CT examination showed a low-density mass only in14cases (12.6%). Before surgery, the15cases of anterior mediastinal bronchogenic cysts failed to confirm the diagnosis, with the diagnosis of anterior mediastinal mass in10cases,of thymoma in4cases and of thymic cyst in one case. In133cases of bronchogenic cysts cases,130cases of the cysts were completely excision, of which two cases with the cyst residual in the mediastinal group and one case with the cyst residual in the pulmonary group.77cases of the mediastinal cyst group were with simple excision, and the other six cases used other surgical methods. In the45cases of intrapulmonary bronchogenic cysts,15cases of cysts were with simple excision,19cases were with lobectomy,9cases were with pulmonary wedge resection,and2cases were with lung segment resection.128cases of bronchogenic cysts located in the chest, of which103cases with thoracotomy (2cases thoracoscopy transited to thoracotomy included in thoracotomy group analysis), and of which25cases with thoracoscopic resection, were compared the operative time, intraoperative blood transfusion, postoperative stay in ICU days, there was no significant difference in postoperative complications (p>0.05),but less blood loss VATS group (115.6±67.9vs182.2±100.9ml) and shorter stay of postoperative hospital (6.3±2.9vs10.7±4.5days) in the thoracoscopy group. The five cases of BC in the neck were complete removal. There were no perioperative deaths or serious complications.There were9cases (6.8%) of postoperative complications, including two cases of incision infection, and seven cases of pleural effusion, all patients were cured. We follow-up127cases (95.5%) and six cases lost follow. Follow-up time was from one month to15years, the average of follow-up time was67months.Cysts located in the esophagus were27cases, including12males and15females,with the average age of42years.There were24cases(88.9%) had clinical symptoms, the most common symptom is difficulty swallowing.20cases (74.1%) of cysts located in esophageal muscle,7cases located in the outer membrane of the esophagus; among which7cases were dense adhesions with the surrounding tissue. There were19cases with thoracotomy,3cases with thoracoscopic (1case due to inability to secure removal of the cyst and turn to thoracotomy),cysts and other tumors combined with resection in2cases, the lesions esophagectomy, stomach esophagus anastomosis in2cases, endoscopic mucosal resection in1case.25cases of cysts were complete removal and2cases of cyst were residual. The group no perioperative deaths. Postoperative esophageal perforation with pleural infection presented in2cases, and these2cases had to undertake re-operation, esophagectomy and cervical esophagogastric anastomosis were undertook, and postoperative recovery was smooth.27cases of cysts located in esophageal postoperative pathology showed:22cases were congenital esophageal cysts and five cases were intramural esophageal bronchogenic cysts. Patients were followed up in25cases (92.6%), two cases of them were lost. Postoperative follow-up time was from5month to20years, with an average follow-up time of63months.Conclusions:(1) Bronchogenic cysts and congenital esophageal cyst have no characteristic clinical symptoms,with a variety of radiographic manifestations and smaller proportion of low density mass and the preoperative diagnosis is difficult, particularly when the cysts in anterior mediastinal and intramural esophageal bronchogenic cysts, MRI have a greater advantage for identification of cysts (2) the bronchogenic cysts (excluding the intramural esophageal bronchogenic cysts) have few postoperative complications, and the postoperative recovery was good. The suitable cases can be considered for thoracoscopic surgery.(3) For the esophagus foregut cysts, they were often located between the esophageal muscle and mucosal layer, and integration with the muscle, especially for dense adhesions cases, we advise to choose thoracotomy for a good surgical exposure,and avoid choosing assisted thoracic surgery;(4) When the cyst is large, and esophageal muscle were dense adhesions, separation may result in damage to the muscle and mucosal layer and leading to ischemia, so the cysts can be considered part of the wall residues, and using the local conservative treatment to avoid serious complications.(5) the congenital esophagus cysts and intramural esophageal bronchogenic cysts were difficult to distinguish before operation,and they were similar clinical manifestations, we advise to study them as a similar type of disease.