儿童肺隔离症的介入治疗

Transcatheter arterial embolization for treatment of pulmonary sequestration in pediatric patients

目的用心导管介入方法治疗肺隔离症.方法 10例平均年龄(9.9±5.8)岁(1～13岁),临床出现反复呼吸道感染、咯血症状,术前经X线胸片、胸部CT和磁共振基本明确诊断为肺隔离症的儿童,经股动脉插管至主动脉弓降部行造影,了解异常血管的起始、直径、数量及回流的静脉,选择大于血管直径30%～40%的蘑菇伞片或金属弹簧圈在降主动脉起始部行异常血管栓塞.结果介入治疗全部成功,无残余瘘.咯血症状当天消失,原有的肺部感染3～5 d内控制;粗大血管堵塞后出现一过性胸痛症状,生命体征稳定,持续2周左右恢复.1～6个月胸片复查,肺部阴影8例完全消退,2例明显缩小仅残留微小淡密度影,且无临床症状.结论肺隔离症介入治疗有效、安全、无手术疤痕,恢复快,可免除开胸肺叶切除手术的损伤.

Objective To introduce a new interventional embolization technique for the treatment of pulmonary sequestration in pediatric patients. Methods Between 1995 and 2004, 10 patients （8 males and 2 females, aged 1 to 13 years with average of 9.9 ± 5.8 years） received the treatment. All patients had repeated respiratory tract infection and hemoptysis. The diagnosis of pulmonary sequestration was confirmed by chest X-ray, thoracic CT and MRI scans. Selective angiography revealed vascular conglomeration and the origin, the diameter and the number of hypertrophic feeding arteries, as well as concomitant venous vessels. The blood-supplying arterial vessel was occluded by placing an Appleatzer or metal spring coil which was 30%-40% larger in diameter than the vessel. Results All the interventional treatments were successful and no fistula remained. The symptom of hemoptysis was immediately relieved and respiratory infections disappeared within 3 to 5 days after the treatment. One patient treated with an Appleatzer complained chest pain for about two weeks, while temperature, heart rate, respiratory rate and blood pressure remained normal. One to six months after the interventional therapy, the chest X-ray examination was performed in all cases. Pre-interventional opacities had disappeared completely in 8 patients, whereas slight densities re- mained in 2 patients without clinical symptoms. Conelusions The interventional treatment is a new option with safe and effective cure, and quick recovery without leaving obvious scars, thoracic surgery for lobe excision can be hence avoided in pediatric patients with pulmonary sequestration.