ABSTRACT
Objective:To explore the feasibility of using ligation clip-assisted modified " expansion and co-llapse method" to determine the intersegment plane in thoracoscopic resection of the external posterior basal segment (S 9+ 10) in children with congenital pulmonary airway malformation (CPAM). Methods:Retrospective study.The clinical data of 12 CPAM children who underwent thoracoscopic S 9+ 10 resection in Children′s Hospital Affiliated to Shandong University from July 2019 to May 2021 were collected and analyzed.There were 7 males and 5 females.The age at operation ranged from 3.50 to 11.50 months.The body weight of patients ranged from 6.5 to 11.5 kg.In all the patients, the ligation clip-assisted modified " expansion and collapse method" was applied during the operation to determine the intersegment plane (S 9+ 10 was in the expansion state and the remaining lungs were in the collapse state) before thoracoscopic S 9+ 10 resection.After S 9+ 10 resection, the surgical treatment and postoperative recovery were summarized and analyzed. Results:All the operations were completed under thoracoscopy, and there was no conversion to thoracotomy.In 11 patients, the intersegment plane was accurately determined by the ligation clips-assisted improved " expansion and collapse method" , and the S 9+ 10 segment was successfully resected.Of these 11 cases, 8 cases had right S 9+ 10 resection and 3 cases had left S 9+ 10 resection.In the process of using the ligation clip-assisted improved " expansion and collapse method" to determine the intersegment plane, the operator needed to clamp the ligation clip after the anesthesiologist expanded the lung completely.Because the operation was not stable enough, the ligation clip fell off and did not clamp S 9+ 10, resulting in operation failure.The operation was changed to the traditional " expansion and collapse method" . Besides, the basal segment bronchus was cut off by mistake, so the right basal segment had to be resected.The operation time ranged from 85 to 205 min, with a median of 149 min.Intraoperative bleeding ranged from 5 to 15 mL, with a median of 10 mL.The indwelling time of drainage tubes ranged from 2 to 4 days, with a median of 3 days.The postoperative hospital stay ranged from 5 to 8 days, with a median of 6 days.Postoperative pathological examination results suggested 4 cases of type 1, 6 cases of type 2 and 2 cases of type 3.There were 2 cases of simple subcutaneous emphysema without postoperative complications such as bleeding, bronchopleural fistula and atelectasis.The follow-up time ranged from 6 to 28 months, with a median of 15 months.The chest CT of all children showed no residual lesions and no residual cavities in the involved hemithorax. Conclusions:Ligation clip-assisted improved " expansion and collapse method" for determining the intersegment plane is suitable for CPAM children with a narrow thoracic space, and the operation is simple and effective.It is relatively safe and feasible to use this method in S 9+ 10 resection.
ABSTRACT
Objective To explore the level of Th2 type cytokines including IL-4, IL-10 and IL-13, and the immunoreg-ulation of cytokines in patients with neurocysticercosis. Methods Lymphocytes in patients with neurocysticercosis were separated from the blood sample with density gradient centrifugation and the total RNA was extracted by guanidine isothiocynate method. cDNA was synthesized by reversed transcription reaction. The target gene was then amplified by PCR. The PCR products were analyzed by electrophoresis. Results Results of RT-PCR showed that cytokines mRNA in lymphocytes of peripheral blcod were detected in 27 patients with neurocysticercosis but not in the other 3 cases. Among the positive cases, mRNA of IL-4, IL-10 and IL-13 was detected in 16, 17 and 14 cases respectively and mRNA of IL-4, IL-10 and/or IL-13 was detected in all the 27 cases. In the detection of lymphocytes in peripheral blcod of 10 healthy subjects, expression of IL-4 and IL-10 was found in only one case at low level. Conclusion The study revealed that Th2 associated cytokines were expressed at high level and the humoral immunocompetence was relatively strong in patients with neurocysticercosis.