Pulmonary cystectomy

Pulmonary cysts (pulmonaryccyst) is a congenital disease caused by embryonic development disorders, which can be divided into bronchogenic cysts and pulmonary parenchymal cysts. Occurs in childhood or youth. Can be single or multiple, generally the wall of the capsule is thin, and the bronchus can form a liquid balloon or contain a balloon swelling, and the cyst can be broken to form a pneumothorax. The general diagnosis is clear, and in the absence of acute inflammation, early surgery should be performed. Because cysts are prone to secondary infections, drug treatment can not cure. On the contrary, due to the inflammatory reaction around the cyst wall after multiple infections, the pleural membrane is widely adhered, which makes surgery difficult and prone to complications. Young age is not an absolute contraindication to surgery. Especially in the case of hypoxia, purpura, respiratory distress, surgery should be done soon, and even emergency surgery can save lives. The surgical procedure should be based on the lesion location, size, and infection: isolated from the subpleural uninfected cyst, which can be used for simple cystectomy; cysts confined to the lung margin can be used for pulmonary wedge resection; cyst infection leads to surrounding Adhesion or adjacent bronchiectasis is performed for lobectomy or pneumonectomy. Bilateral lesions, on the premise of surgical indications, can be the first side of the lesion. Pediatrics are based on the principle of keeping normal lung tissue as much as possible. When the disease is diagnosed clinically, chest puncture should be avoided as much as possible to avoid chest infection or tension pneumothorax. Only in a few cases, severe respiratory distress syndrome, purpura, severe hypoxia, and unconditional emergency surgery, can be used as a cyst puncture drainage, to achieve temporary decompression, relieve respiratory distress symptoms, as a temporary emergency before surgery Measures. The lesion cyst or lobes are generally removed and the prognosis is good. If the adult patient has a large amount of preoperative sputum, a double lumen endotracheal intubation anesthesia is required during surgery to prevent the sputum from flowing back to the opposite side. In children, the lower prone position of the affected side can be used to open the chest. After the chest is inserted, the lung and bronchus are ligated. Treatment of diseases: congenital pulmonary cysts Indication Pulmonary cysts can not heal themselves, such as complications such as co-infection, cancer, and tension pneumothorax after rupture can make the condition more complicated. Therefore, once diagnosed, surgery should be performed as soon as possible. Asymptomatic pulmonary cysts can be scheduled for surgery, and the following should be treated as an emergency. 1. The volume of the lung cyst has exceeded 1/3 of the chest cavity on one side. 2. The cyst is ruptured to form a tension pneumothorax or a pneumothorax. 3. Cysts with infection, generally should be treated with effective antibiotics, after the symptoms of poisoning are relieved, and then elective surgery. For medical treatment is ineffective, infection can not control or continue hemoptysis, in the absence of open chest contraindications, adequate preparation, surgery can be considered. Preoperative preparation Patients with sputum, cysts and infected patients should use effective antibiotics to control infection in advance, active use of body position drainage, aerosol inhalation, oral sputum drugs, the amount of sputum control at an ideal level, is very important to reduce postoperative complications. Surgical procedure Surgery should be based on the size, location, single or multiple of the lung cyst and the degree of infection to choose a different procedure. Small and isolated pulmonary cysts are feasible for segmental resection. Local excision or wedge resection can also be used for small cysts around the lung. Large cysts close to the hilar, limited to multiple cysts or cysts of a lobe, combined with infection, difficult to perform segmentectomy, feasible lobectomy. If multiple pulmonary cysts involve the entire lung, pneumonectomy should be performed. Pulmonary cysts with bronchial traffic should be treated with gentle operation to prevent squeezing cysts, causing a large amount of secretions to flow into the trachea, causing suffocation and infection spread. If necessary, the lung bronchus can be controlled first after entering the chest. Pulmonary cysts and infections have adhesions to the surrounding structures. When dissecting adhesions, they should be carefully separated under direct vision. Note that pulmonary cysts may be associated with other congenital malformations. There may be congenital concealed traffic between the esophagus and the bronchi. The anatomy of the mediastinal surface of the left and right lower lungs should pay special attention to the abnormal arterial branches. You can first touch the abnormal pulsation and then separate the adhesion to prevent the major blood vessels from retreating after the abnormal blood vessels are cut off. Patients with severe pleural adhesions should stop bleeding completely before surgery to prevent complications such as hemothorax.

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