Clinical Analysis Of Endoscopic Surgery For 45 Children With Pulmonary Sequestration

ObjectiveTo analyze the preoperative clinical manifestations and auxiliary examination characteristics of children with pulmonary sequestration,to discuss the surgical timing and feasibility of surgical treatment of pulmonary sequestration under laparoscopic approach,and to summarize postoperative complications and their treatment.MethodA retrospective analysis was performed on 45 children with pathologically confirmed pulmonary sequestration who were admitted to the hospital from January 2015 to December 2017 for a total of 36 months.The preoperative clinical manifestations of children with pulmonary sequestration were summarized and clinically assisted.Selection of examination methods,surgical treatment and treatment of postoperative complications.ResultPulmonary sequestration often has no specific symptoms or signs in clinical practice.Most of them are mainly respiratory symptoms,including 13 cases of respiratory tract infection,4 cases of hemoptysis,2 cases of dyspnea,1 case of chest mass,and 25 cases of prenatal ultrasound screening.Pediatric pulmonary sequestration was diagnosed partly by prenatal ultrasonography.After the birth,chest enhanced CT was used to confirm the diagnosis.In some cases,chest-enhanced CT,MRI,or DSA was performed for clinical respiratory symptoms.40 patients with pulmonary sequestration were identified preoperatively.Thirty-two children underwent thoracoscopic excision and three patients underwent laparoscopic excision.Among them,2 patients suffered from intraoperative lesion persistence,severe adhesions,and bleeding,resulting in conversion to thoracotomy.The rest 42 patients All operations were performed successfully under thoracic/laparoscopy.There were 25 cases of intra-lobar pulmonary sequestration,18 cases of extra-lobar pulmonary sequestration,and 2 cases of broncho-pulmonary intestine malformation.There were 40 isolated lungs in the thoracic cavity and 5 in the thoracic cavity(3 intraperitoneally and 2 in the diaphragm).There were 15 cases of complications after surgery,including 2 cases due to more pleural effusion(chest B-ultrasound pleural effusion ? 4cm),1 case of severe compression of lung tissue due to pneumothorax,while experiencing shortness of breath,labor and other symptoms,The thoracic puncture and drainage was performed on the thoracic ultrasonography,and the remaining cases were all cured after symptomatic treatment with antibiotics and promoted discharge.No operative deaths occurred.Compared with children diagnosed with pulmonary sequestration due to respiratory symptoms,antenatal ultrasound is a screening procedure and postpartum children with no respiratory symptoms,have fewer postoperative complications,faster recovery,and hospitalization.The time is shorter and the hospitalization cost is lower.ConclusionPediatric pulmonary sequestration and more no obvious specific symptoms and signs,can not be easily diagnosed before surgery,the clinical misdiagnosis rate and the rate of missed diagnosis is higher.At present,the auxiliary diagnosis mainly depends on prenatal ultrasound examination and postpartum chest-enhanced CT.After the diagnosis of pulmonary sequestration,especially in children with previous history of pulmonary infection,early treatment,the preferred surgical resection of diseased tissue.For prenatal ultrasound screening,postpartum chest enhanced CT was diagnosed as pulmonary sequestration,and in children with no clinical symptoms,we recommend surgical treatment as soon as possible to avoid late lung infection,persistent lesions,and more surgery.Difficulties,prolong the recovery time of children and increase hospitalization costs.At present,the laparoscopic technique is quite mature in China.The history of laparoscopic application in our hospital has been used for many years.A high success rate and a postoperative recovery rate have proved safe and effective for the decompression of the decompressed lung.For the postoperative complications of endoscopic surgery,routine use of broad-spectrum antibiotics against common bacteria in the lungs and promotion of children's expectoration have helped in the recovery of children.A small amount of pneumothorax,subcutaneous gas accumulation,pleural effusion,etc.can be self-absorbed.When there is a large amount of gas accumulation effusion affecting respiratory function,it is necessary to perform thoracentesis and drainage.