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咯血患儿肺叶切除术麻醉管理一例

Misdiagnosis Analysis of Pulmonary Sequestration

ObjectiveTo explore the status,reasons and precautions of misdiagnosis of pulmonary sequestration. MethodsSeventy-seven articles about pulmonary sequestration published in Wanfang and CNKI databases between January 2005 and December 2013 were retrospectively analyzed,of which 41 articles referring to misdiagnosis rate.The misdiagnosis rate,time,status,consequence,reason and main means of definite diagnosis were analyzed. ResultsThe total number of cases of pulmonary sequestration in the 41 articles was 689,in whom 399 cases were misdiagnosed.Misdiagnosis rate was 57.91%.The minimum misdiagnosis time was 14 days and the maximum was 40 years.Pulmonary sequestration was most often misdiagnosed as pulmonary cyst(23.16%),bronchiectasis(22.73%),lung cancer(20.08%),lung abscess(6.93%)and pneumonia(6.28%).Most misdiagnosed patients did not suffer adverse consequences,except 4 patients were dead and 1 patient undertook unnecessary extended operation.Lack of specificity in clinical manifestations,lack of awareness of the disease,diversity of imaging performance and complications covering the original disease were the most common reasons of misdiagnosis.Postoperative pathological examination(83.77%),intraoperative findings(13.42%)and computed tomography angiography(2.16%)were the main means of definite diagnosis in misdiagnosed cases. ConclusionPulmonary sequestration is lack of specificity in clinical manifestations and easy to be misdiagnosed.Imaging showing the abnormal blood supply vessels is the key to the diagnosis.Improving the awareness of it can reduce misdiagnosis and incorrect treatment.

The Diagnosis and Surgical Treatment of Pulmonary Sequestration

Abstract: Objective To summarize the clinical experiences and surgical treatment of pulmonary sequestration (PS) in order to improve the diagnosis and treatment of PS. Methods Between August 1993 and February 2007, our department enrolled 21 PS patients, 8 male patients and 13 female patients, with the age ranging from 13 to 70 years old. The patients were examined by chest radiography, computerized tomography (CT), computerized tomography angiography (CTA), magnetic resonance imaging (MRI), position emission tomographyCT(PET-CT) before the surgery. Sequestrectomy was performed on patients with extralobar sequestration (ELS) and lobectomy was performed on patients with intralobar sequestration (ILS). There were 10 cases of left lower lobectomy, 3 cases of right lower lobectomy, 4 cases of left sequestrectomy, 3 cases of right sequestrectomy and 1 case of total pneumonectomy. Results Postoperative pathology confirmed all cases of PS, including 7 cases of ELS and 14 cases of ILS. Seven patients were diagnosed to have PS by preoperative diagnostic procedures. During the surgery, we found aberrant supporting arteries from the general circulation in 18 cases among which 11 were supported by the thoracic aorta, 6 by the abdominal aorta and 1 by both the thoracic and abdominal aorta. The diameter of the aberrant artery was between 0.2 cm and 1.1 cm (mean 0.7 cm). Double ligation and transfixion were performed during the operation. In addition, we found venous drainage through the inferior pulmonary vein in 3 patients and double ligation was performed. No perioperative death or complications occurred. Followup was done till January 2009 on all the patients but one with a followup rate of 95.2% (20/21). The followup time ranged from 12 to 67 months. All patients survived well except that 1 died from liver metastasis 2 years after the operation because of lung cancer. Conclusion PS is rare and its symptoms are nonspecific, which can cause misdiagnosis and missed diagnosis. The diagnosis of PS mainly depends on CT, CTA, MRI and selected arteriography. Once diagnosed, PS should be removed by surgery. During the surgery, aberrant vessels should be separated and treated with double ligation and transfixion. As for those big aberrant vessels, transfixion can be performed after vascular decompression.

Clinical Diagnosis and Therapy of Pulmonary Sequestration

【摘要】 目的 分析总结肺隔离症（PS）的临床诊断及治疗方法。 方法 回顾分析2000年2月-2009年10月确诊的27例PS患者临床特征、诊断方法及治疗手段。 结果 27例PS患者均经影像学和手术确诊，其中叶内型22例，叶外型5例，行左下肺切除17例，右下肺切除10例；全部手术切除。术后并发胸腔积液1例，肺不张2例，分别给予穿刺抽液、纤维支气管镜吸痰等积极治疗后痊愈，其余患者恢复较好，随访6~60个月无复发。 结论 PS手术前误诊率高，诊断方法主要为X线平片、CT及CT增强血管照影（CTA）检查。CTA可显示异常供血动脉，是诊断PS的首选检查方法。一经明确诊断应尽早给予治疗，治疗方案主要包括手术和螺圈栓塞。【Abstract】 Objective To summary the diagnosis and therapy of pulmonary sequestration. Methods Clinical symptoms, methods of diagnosis and treatments of 27 patients diagnosed with pulmonary sequestration from February 2002 to October 2009 were analyzed retrospectively. Results Twenty-seven patients were all confirmed by imaging and surgery, and had undergone surgical excision. Twenty-two patients were with intralober pulmonary sequestrateon (IPS) and five were with extralober pulmonary sepuestration (EPS); 17 patients were treated by left lower lobectomy, and 10 patients required right lower lobectomy. After the surgery, there were one patient with pleural effusion and two patients with atelectasis who suffered from complications postoperatively, and they were healed by symptomatic treatment. The rest recovered well. There were no recurrence from six to 60 months follow-up. Conclusion Pulmonary sequestration may be misdiagnosed easily. The main methods for the examination include X-ray,CT and CTA. CTA can detect anomalous systemic artery,which should be the first choice in diagnosing of pulmonary sequestration. Surgery and coil embolization are the main treatments. Once being confirmed,pulmonary sequestration should be treated as soon as possible.

21例肺隔离症的外科治疗

目的 总结肺隔离症的外科治疗经验，以提高诊治水平。 方法 回顾分析1990年5月～2006年4月收治21例肺隔离症患者的临床资料，其中叶内型18例，均行病变肺叶切除术；叶外型3例，行肺局部隔离病变切除。术前明确诊断14例，误诊7例。 结果 全部患者均经外科手术治愈,无并发症发生。随访 6个月~9年，2例失访，其余19例无复发，均健在。 结论 肺隔离症是一种少见的先天性肺发育畸形疾病，临床常误诊为支气管扩张、肺囊肿和肺癌。手术治疗肺隔离症是较为有效的方法。

儿童左肺囊肿伴感染行左全肺切除术肺隔离失败一例

疑似肺癌的隐蔽性肺隔离症一例

异常供血动脉起源于腹腔干的右侧肺隔离症一例

肺隔离症误诊为脓胸一例

临床资料 患者女性, 21 岁。因“反复咳嗽1 年余”入院。患者1 年前无明显诱因出现咳嗽, 无痰, 无发热、盗汗、乏力。当地医院给予抗感染治疗症状缓解。以后患者反复出现干咳, 口服抗生素及止咳药好转。2 周前又出现干咳,到当地市立医院就诊。胸片示右侧胸腔积液; 胸腔彩超示右侧胸腔包裹性积液, 内部可见粗点状回声及分隔光带回。血白细胞11. 02 ×109 /L, 中性粒细胞0. 499, 淋巴细胞0. 408;胸腔穿刺共抽出30 mL 脓液, 查胸水白细胞11 400 ×106 /L,中性粒细胞0. 41, 淋巴细胞0. 59。给予头孢哌酮/ 舒巴坦3 g静脉滴注, 2 次/d, 治疗1 周, 患者仍干咳, 并出现右侧胸部不适。‥‥‥

Right visual double lumen endotracheal tube versus common right double lumen endotracheal tube lung isolation technique: A randomized controlled study

ObjectiveTo compare the clinical efficacy between right visual double lumen tube (VDLT) intubation and right common double lumen tube (DLT) intubation in lung isolation technique. MethodsA total of 57 patients undergoing thoracoscopic surgery with right DLT lung isolation technique in the First People's Hospital of Chenzhou City and West China Hospital from June 2020 to June 2021 were randomly divided into two groups: a DLT group (n=29, 16 males and 13 females, with a mean age of 54.3±13.2 years) and a VDLT group (n=28, 18 males and 10 females, with a mean age of 55.1±13.7 years) at 1 : 1 with random number table generated by the computer. The clinical data of the two groups were compared. ResultsCompared with the DLT group, the catheter positioning time in the VDLT group was statistically shorter (74.9±47.5 s vs. 151.6±88.9 s, P<0.001), the right upper lung occlusion rate (21.4% vs. 51.7%) and the intraoperative re-adjustment catheterization rate (14.3% vs. 48.3%) were lower (P<0.05). The quality of lung collapses immediately after thoracotomy (67.9% vs. 24.1%) and 20 minutes after thoracotomy (100.0% vs. 75.9%) were improved (P<0.05). There was no significant difference in the rate of fiberoptic bronchoscope assistance for positioning, or the incidence of pharynx pain and hoarseness between the two groups (P>0.05). ConclusionCompared with common DLT, VDLT is more efficient, accurate and intuitive in the location of right bronchial intubation.