Pediatric surgery. Treatment of congenital cysts (most important)

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Pediatric surgery. Treatment of congenital cysts (most important)

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10. Treatment of congenital cysts

All congenital pulmonary cysts are subject to surgical treatment, however, the timing of the operation is determined by the course of the disease, the condition of the child.

Preoperative depends on the nature of the complication. An infected cyst or cysts of the lung require intensive complex therapy, which is a kind of preoperative preparation. Therapeutic measures in these patients are aimed at removing intoxication, restorative therapy.

Sanitation the purulent cavity is produced by puncturing it, with the suction of pus, washing with antiseptic solutions and the introduction of antibiotics. The cyst is punctured again after 2-3 days (depending on the accumulation of exudate). At the same time, the patient is prescribed therapeutic exercises with a drainage position.

With insufficient drainage function of the afferent bronchus, it is advisable to include repeated tracheobronchoscopy in the complex of therapeutic measures.

As a result of the rehabilitation of the purulent focus, the patient's symptoms of intoxication are reduced, which is also facilitated by vigorous general strengthening therapy - transfusion of blood, plasma, intravenous fluids, parenteral administration of vitamins and massive antibiotic therapy.

Operative therapy. The extent of the operation depends on the nature of the pathological process.

With single cysts, surgery can be reduced to thoracotomy and cyst exfoliation.

Operation technique. Thoracotomy is performed according to the general rules with an anterolateral incision. The lung is isolated from the adhesions. The pleura is carefully dissected over the cyst, after which the lung is gradually peeled off from the wall of the cyst. The fibrous cords that connect the cyst to the surrounding lung tissue are cut and ligated.

There are especially many strands on the basal pole of the cyst. Here, the passage of fairly large vessels and one or more bronchial branches that communicate with the cyst is possible.

They are ligated with silk. Bleeding areas of the lung edge are sheathed with catgut. If it is impossible to enucleate the cyst, a lobectomy is performed according to the general rules. After removal of the cyst in the pleural cavity, drainage is left for 24-48 hours.

The extent of surgery for polycystic lung depends on the extent of the lesion. With lobar localization, the operation is reduced to a lobectomy. In the case of cystic degeneration of the entire lung, a pneumonectomy is performed.

Postoperative treatment. In general, the treatment of patients who have undergone surgery for lung cysts does not differ from that for lobar emphysema. After removal of previously infected cysts, special attention should be paid to antibacterial therapy. Careful care of the postoperative wound is also necessary - daily dressings, treatment of sutures, ultraviolet irradiation.

Authors: Drozdov A.A., Drozdova M.V.

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