| Objective To analyze and summarize the clinical characteristics,diagnosis and treatment of pulmonary sequestration aim to improve the awareness of clinicians about pulmonary sequestration(PS).Method A retrospective analysis of the clinical data of patients with PS diagnosed in the First Affiliated Hospital of Guangxi Medical University between September 1,2012 and February 1,2019 was performed.SPSS23.0 was used to analyze the collected data.Result 1.There were 49 patients with PS,28 males and 21 females.The ratio of male to female was 1.33:1.The main clinical manifestations were cough,sputum,hemoptysis.The mean age of the PS patients was 31.3±17.3 years,which were mainly between 20 and 40 years old.The course of disease ranged from 1 day to 20 years,23 cases had a course of more than 3 months,12 cases had a course of 1-3 months and 14 cases had a course of less than 1 month.2.The main manifestations of chest CT were mass,bronchial cystic dilatation and atelectasis.The specificity and sensitivity of chest-enhanced CT in diagnosis of PS were 100% and 76.7%.Spiral CT three-dimensional reconstruction or CTA can clearly show the abnormal blood supply artery.3.Detection of serum tumor markers showed there were tumor markers elevated,among which CEA,CA125,NSE and CA199 were the main ones.Bronchoscope showed inflammatory changes or normal.The main manifestations of pulmonary function test were mild ventilation dysfunction or normal.4.Of the 49 cases,22 cases were misdiagnosed before operation(44.9%).Patients with bronchiectasis on CT were all misdiagnosed as bronchiectasis before operation(100%).When the CT manifestations were mass,the preoperative misdiagnosed rate was 45.7%.There was significant difference between the two groups(P <0.05).5.Surgical treatment was performed in 46 cases,including thoracotomy in 16 cases,thoracoscopic surgery in 30 cases,pulmonary sequestration occlusion in 1 case,and conservative treatment in 2 cases.There was no significant difference between thoracotomy and thoracoscopic surgery in age,volume of intraoperative blood loss,duration of postoperative drainage,application time of antibiotics after operation,total hospitalization time and hospitalization cost(P > 0.05).The postoperative hospitalization time of thoracotomy group was 7(3)days,and that of thoracoscopic surgery group was 5(3)days.There was significant difference between the two groups(P <0.05).The postoperative hospitalization time of thoracoscopic surgery group was shorter than that of thoracotomy group.In the thoracoscopic surgery group,1 case(3.3%)had severe hemorrhage during the operation and had no reoperation patient.In the thoracotomy group,2 patients(12.5%)underwent reoperation for advanced hemothorax.6.The main pathological manifestations were bronchiectasis,acute and chronic inflammation and bronchial cyst.One case was complicated with pulmonary tuberculosis,one with fungal infection and one with micro-atypical adenoma hyperplasia.7.One patient with PS underwent whole genome microarray examination.The results showed that the short arm of chromosome 16(16p11.2)was deleted and the long arm of chromosome 14(14q32.33)duplicated.Conclusion 1.The main clinical manifestations of pulmonary sequestration were cough,sputum,hemoptysis.The age of the PS patients were mainly between 20 and 40 years old.The lesions were mainly located in the posterior basal segment of the left lobe of the lung.It is difficult to differentiate it from other diseases by laboratory examination.Relying on CTA,Enhanced CT Three-dimensional Reconstruction and DSA to diagnosis.When abnormal blood supply arteries were found during operation we can diagnosis PS,or we can diagnose PS by pathology.2.The CT manifestations showed bronchiectasis were more likely to be misdiagnosed than that showed mass.3.Thoracoscopic surgery had shorter postoperative hospitalization time than thoracotomy,and fewer complications.Thoracoscopic surgery was better than thoracotomy in the treatment of PS. |
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