Treatment of Pulmonary Sequestration with Thoracoscopic Approach.
- Author:
Min Jeng CHO
1
;
Tae Hoon KIM
;
Dae Yeon KIM
;
Seong Chul KIM
;
In Koo KIM
Author Information
1. Division of Pediatric Surgery, University of Ulsan College of Medicine & Asan Medical Center, Seoul, Korea. kimdy@amc.seoul.kr
- Publication Type:Original Article
- Keywords:
Pulmonary sequestration;
Asymptomatic;
Thoracoscopic resection
- MeSH:
Abscess;
Bronchopulmonary Sequestration;
Compliance;
Humans;
Iliac Artery;
Lost to Follow-Up;
Medical Records;
Renal Artery;
Respiratory System;
Retrospective Studies;
Sepsis;
Thoracic Surgery;
Thoracotomy
- From:Journal of the Korean Association of Pediatric Surgeons
2010;16(2):154-161
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
Pulmonary sequestration (PS) is a rare congenital malformation of the lower respiratory tract. The anomaly is characterized by absence of communication with the tracheobronchial tree and isolated blood supply from an anomalous systemic vessels. With the utilization of antenatal ultrasound, the diagnosis of asymptomatic neonatal PS has increased. Treatment options include observation, arterial embolization and surgical resection. The aim of the present study is to review the clinical course of PS and to share our experience with thoracoscopic resection. A total of 96 patients with PS were treated at Asan Children's Hospital between 1999 and 2010. The diagnosis of PS was established by CT in the cases managed by observation or embolization, and by tissue pathology in the surgical cases. Medical records and radiographic images were retrospectively reviewed. Thirty-nine patients were managed by embolization and 30 patients by surgery. The remaining 27 patients have been under observation without any procedures. Among 27 observation patients, 1 patient regressed completely and 10 patients were lost to follow up. Of the 39 embolizations patients, 2 had their lesion regress and sepsis was suspected after embolization. In 1 patient, the microcoil migrated to the iliac artery during the embolization procedure, and another patient developed renal abscess caused by renal artery embolization. Among 30 surgical cases, resection by thoracotomy was performed in 27 at the Department of Thoracic Surgery, and thoracoscopic resection in 3 at the Division of Pediatric Sugery. Only one wound complication ocurred. We conclud that surgical excision should be recommended for pulmonary sequestration, whether the sequestration is symptomatic or not because of the risk of infection, the low rate of natural regress, poor compliance, severe complications after embolization, and to exclude other pathology. In summary, thoracoscopic resection of the pulmonary sequestration is feasible, efficacious, safe and cosmetically superior even in neonatal period.
