| BackgroundPulmonary sequestration(PS)is a kind of rare congenital malformation of the lungs,only in 0.15%-6.4%.Pulmonary sequestration was first reported by Huber in 1777,which was named as "Deputy lung" by Rokitansky.It was named as'sequestration' by Pryce in 1946.The pathogenesis of pulmonary sequestration was that a part of lung tissue developed into a separate lesion in the embryonic period,which had no respiratory function but had aberrant arterial supply.According to whether the pulmonary sequestration had common visceral pleura or not,it could be divided into two types:Intralobar sequestration(ILS)and Extralobar sequestration(ELS).ILS,which had not common visceral pleura itself,but shared with the adjacent lung tissues.The symptoms of ILS were varied.ILS often easily acquired pulmonary infections,manifested as fever,cough,purulent sputum,etc.ELS which was wrapped by independent visceral pleura.However,ELS was generally asymptomatic or accidentally discovered on routine physical examination.The patients of PS should be advised for surgical treatment.There were two types of surgery,traditional surgery and Video-assisted thoracic surgery(VATS).Our research aims to investigate 51 cases of children PS in VATS with clinical data from February 2014 to December 2018 and summarize the clinical treatment effects and safeties,which were used for offer help for treatment of pulmonary sequestration.MethodsThe clinical data of 51 children who were diagnosed with PS and treated by VATS in Qilu Children's Hospital of Shandong University(Jinan,China)between February 2014 and December 2018 was collected.The clinical data of 51 children including age,gender,surgical time,treatment methods and effects were summarized and analyzed retrospectively.Results1.A total of 51 confirmed cases(ILS 38 cases,ELS 12 cases,mixed ILS/ELS 1cases.27 males and 24 females;gender ratio:1.18:1)were collected in this study.The ages ranged from 1.5 months to 145 months old(average age:28.41±37.60months).Among them,12 cases(24%)aged?6 months,16 cases(31%)aged?1 year old,14 cases(27%)aged?3 years old,2 cases(4%)aged?6 years old,4 cases(8%)aged?9 years old,3 cases(6%)aged?12 years old.2.Among the 38 cases ILS,18 were males and 20 were females,gender ratio:1.11:1,the ages ranged from 1.5 months to 145 months old(average age:30.24±40,39 months).16 patients showed nonspecific symptoms:cough:4 cases,fever and cough:9 cases,polypnea:1 case,pneumonia:2 cases,none of symptoms:22 cases.Pathogenic site:inferior lobe of left lung(18 cases),inferior lobe of right lung(19 cases),upper lo'be of left lung(1 case).Malformations:(1 case was congenital thumb polydactyly;1 case was cryptorchidism of right side).1 case with rhabdomyoma.Operation method:Left inferior lobectomy(13 cases),right inferior lobectomy(14 cases),left superior lobe irregular resection(1 case),left inferior lobe irregular resection(5 cases)?right inferior lobe irregular resection(3 cases)?basal segmentectomy of the right inferior lobe(2 cases).Source of abnormal supplying arteries:thoracic aorta(24 cases),aorta abdominalis(2 cases),celiac axis(6 cases),phrenicartery(2 cases),thoracic aorta and celiac axis(1 case),unclear(3 cases).Abnormal vessel count:1count(35 cases),2 counts(1 case),3 counts(1 case),4 counts(1 case).Venous drainage:left inferior pulmonary vein(9 cases),right inferior pulmonary vein(11 cases),right upper pulmonary vein(1 case),left renal vein(1 case),azygos vein(2 cases)?right inferior and upper pulmonary vein and venae cava inferior(1 case),unclear(13 cases).The operation time ranged from 50 min to 380 min(average time:114.9±55.93 min).Intraoperative blood loss ranged from 5ml-30ml(average:11.58±6.69 ml).Indwelling time for closed thoracic drainage ranged from 3 d to 11 d(average time:4.55±1.75d).Postoperative stay ranged from 3d to 15d(average time:7.92±2.57 d).Among the 12 cases of ELS,8 were males and 4 were females,gender ratio:2:1,the ages ranged from 2 months to 96months old(average age:23.42 ± 29.88 months).8 patients showed nonspecific symptoms:cough:2 cases,fever and pain:1 case,cough and polypnea:1 case,fever and cough:4 cases,none of symptoms:4cases.Pathogenic site:The left rib phrenic Angle(8 cases),The right rib phrenic Angle(3 cases),Right diaphragm(1 case).Malformations:(1 case was diaphragmatic hernia;1 case was congenital pulmonary airway malformation).1 case with infarction of torsion.Source of abnormal supplying arteries:thoracic aorta(4 cases),aorta abdominalis(1 case),celiac axis(2 cases),posterior intercostal artery(1 case),unclear(4 cases).Venous drainage:left inferior pulmonary vein(1 case),Inferior vena cava(1 case),azygos vein(1 case),unclear(9 cases).The operation time ranged from 65 min to 115 min(average time:80.42± 16.3min).Intraoperative blood loss ranged fromlml-30ml(average:11.33 ±8.17ml).Indwelling time of closed thoracic drainage ranged from 0 d to 6 d(average time:3.33 ± 1.87 d).Postoperative stay ranged from 3d to 12d(average time:6,67±2.61 d).Between ILS and ELS,there is no exactly difference in terms of gender,first diagnosed age,the incidence of two lobes complicated malformations,Intraoperative blood loss,indwelling time for closed thoracic drainage,postoperative stay time.The operation time of ELS was shorter than that of ILS.,the difference was statistically significant(P<0.05).3.26 patients were discovered by prenatal ultrasound(21 cases were ILS,4 cases ELS).Other patients were discovered when they have symptoms by Imaging examination.All patients confirmed by Enhanced CT before operation.The age of the patients who confirmed PS by prenatal ultrasound were younger than the others not,the difference was statistically significant(P<0.05).4.Among the 38 cases of ELS,27 cases underwent lobectomy,and no postoperative complications.9 cases underwent irregular resection,2 cases underwent segmental resection,and 3 of them had postoperative complications.There was statistical difference between them(P = 0.023).5.All patients have no serious complications and per:ioperative death.Postoperative follow-up from 2 months to 57 months.1 patient was found have pneumothorax 15 days after lobe irregular resection,and recovered after 34 days after re-placement of closed thoracic drainage.The other cases were cured and have a good prognosis.Conclusion1.Between ILS and ELS,there is no exactly difference in terms of gender,first diagnosed age,the incidence of two lobes complicated malformations,intraoperative blood loss,indwelling time for closed thoracic drainage,postoperative stay time.The operation time of ELS was shorter than that of ILS.2.The age of the patients who confirmed PS by prenatal ultrasound were younger than the others not.3.In children with ILS,there were fewer complications after lobectomy than those after segmental and irregular lobectomy.The lobectomy was more thorough and safe.4.PS should be treated by surgery once diagnosed.VATS is a safety method to treats children PS,it can be a preferred way for PS treatment. |
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