| Objective: Combined with the clinical data of 77 patients with pulmonary sequestration,the clinical features,diagnosis and treatment methods,and misdiagnosis analysis of pulmonary sequestration were discussed to improve the clinical understanding of pulmonary sequestration and reduce the misdiagnosis of pulmonary sequestration.Methods: The clinical data of 77 patients with pulmonary sequestration diagnosed in the first affiliated Hospital of Guangxi Medical University from January 2005 to January 2020 were collected.Their clinical symptoms,signs,imaging findings,pathological results,diagnosis,and treatment were analyzed retrospectively.Results:(1)There were 12 cases(15.6%)in the non-adult group,including eight males and four females,ranging in age from 3 days to 17 years old,of which 5 cases complicated with other congenital malformations.There were 65cases(84.4%)in the adult group,including 34 males and 31 females,aged from21 to 69 years old,with an average(40.91 ±14.43)years,of which 2 cases complicated with other congenital malformations.There were significant differences in age constituent ratio and associated deformities between the adult group and thenon-adult group(P < 0.05).(2)11 cases(91.7%)in the non-adult group treated because of respiratory symptoms,including 10 cases with cough and expectoration(83.3%).The main systemic symptoms were fever in 9 cases(75.0%).Pulmonary signs were positive in 10 cases(83.3%).51 cases(78.5%)in the adult group treated because of respiratory symptoms,including 46 cases with cough and expectoration(70.8%).The main systemic symptoms were fever in 16 cases(24.6%).Pulmonary signs were positive in 24 cases(36.9%).The cough was more common in respiratory symptoms than other symptoms.There was a considerable difference in fever and lung signs between the adult group and the non-adult group(P < 0.05).(3)In the non-adult group,10 cases underwent a chest CT or a chest-enhanced CT examination,including mass/nodule shadow in 5 cases(50.0%),the cystic shadow in 6 cases(60.0%),and flake shadow in 2 cases(20.0%).In the adult group,54 cases underwent a chest CT or a chest-enhanced CT examination,including mass/nodule shadow in35 cases(64.8%),the cystic shadow in 4 cases(7.4%),the flaky shadow in 13cases(24.1%),and cystic or columnar dilatation shadow in 6 cases(11.1%).There was a significant difference in cystic changes between the adult group and the non-adult group(P < 0.05).(4))The number of tumor markers increased,among which CA199,CA125 was the most significant.Under bronchoscope,the main manifestations were mucosal congestion and swelling and viscous secretions in the official cavity.(5)59 cases received surgical treatment,7 cases in the non-adult group underwent thoracotomy,1 case underwent video-assisted thoracoscopic surgery,and 1 case underwent ductus arteriosus occlusion.In the adult group,23 cases underwent thoracotomy and 27 cases underwent video-assisted thoracoscopic surgery.(6)The pulmonary sequestration mainly occurred in the basal segment of the lower lobe of the left lung,including 8cases in the non-adult group(66.7%)and 47 cases in the adult group(72.3%).The abnormal vascular mostly found in the thoracic aorta or descending aorta,including 10 cases(90.9%)in the non-adult group and 45 cases(77.6%)in the adult group.Most of the abnormal vascular branches were 1 branch,including 8cases(72.7%)in the non-adult group and 45 cases(94.8%)in the adult group.(7)Among the 77 patients,29 patients misdiagnosed as other diseases,of which25 cases misdiagnosed as tumor(15 cases),bronchiectasis(6 cases),pulmonary cyst(5 cases)and lung abscess(3 cases)without chest-enhanced CT examination(15 cases),bronchiectasis(6 cases),lung abscess(3 cases).Conclusion(1)The age of diagnosis of pulmonary sequestration is more common in adulthood.(2)The non-adult cases complicated with other congenital malformations,and symptoms and signs are more common than adult cases.(3)Pulmonary sequestration is most common in the lower lobe of the left lung.The imaging findings are mainly mass,and some are cystic changes.Non-adult patients are more likely to have pulmonary cystic changes.(4)Abnormal blood supply vessels can be diagnosed by imaging or finding abnormal blood supply vessels during operation.;Misdiagnosis is common in patients without a chest-enhanced CT examination.(5)Pulmonary sequestration has an excellent therapeutic effect and a good prognosis. |
