肺隔离症27例临床特点分析

Bronchopnlmonary sequestration： review of 27 cases

目的探讨肺隔离症的临床特点，提高肺隔离症临床诊断和治疗水平。方法回顾性分析1999年1月至2006年12月浙江大学医学院附属第一医院收治的27例经病理证实为肺隔离症患者的临床资料并复习相关文献。结果27例中，男18例，女9例，年龄11～65岁，平均34岁。病程1个月至20年。主要症状为反复咳嗽、咳痰、低热、咯血、胸闷及胸痛。4例无任何症状。27例肺隔离症患者中叶内型22例，叶外型5例，叶内型常有咳嗽、咳痰、发热、咯血等症状，叶外型多无症状。术前确诊或拟诊20例，主要诊断手段为X线胸片、胸部CT平扫及增强扫描、CT血管造影（CTA）、核磁共振血管造影（MRA）及选择性动脉造影。本组所有病例均行手术治疗，术后恢复顺利，随访未见复发。结论肺隔离症临床表现无特异性，选择性动脉造影对本病的确诊有决定性意义，但为有创检查。CT增强、CTA和MRA等非侵袭性血管成像技术已成为选择性动脉造影的重要补充手段，手术为最佳治疗方法，介入治疗效果有待进一步研究。

Objective To explore the clinical manifestations, the diagnosis and the treatment of bronchopulmonary sequestration. Methods Twenty-seven cases of bronchopulmonary sequestration confirmed by histopathological studies were analyzed and related literatures were reviewed. Results Among the 27 cases of bronchopulmonary sequestration, 22 were intralobar type, and 5 were extralobar type. All the patients with intralobar type had symptoms including cough, expectoration, fever, hemoptysis, but the 5 cases of extralobar type had no symptoms. Twenty cases were confirmed before operation by chest radiography, plain CT scan, enhanced CT scan, CT angiography, MR angiography, or selective arteriography. Chest operation was performed in all the cases, with successfully recovery after the operation, and no relapse was found. Conclusions The clinical manifestations of bronchopulmonary sequestration are nonspecific. Selective arteriography, although invasive, plays a pivotal role in the diagnosis. Non-invasive angiography including enhanced CT scan, CT angiography, and MR angiography have become important supplements to selective arteriography. Surgery is the optimal treatment, while the effect of interventional therapy needs further study.