肺隔离症19例的诊断与治疗

Diagnosis and Treatment of 19 Children with Pulmonary Sequestration

目的总结小儿肺隔离症的临床特点及诊治经验。方法回顾性分析2003年3月-2008年5月在本院经影像学检查和(或)手术确诊为肺隔离症的19例患儿临床资料。19例中男13例,女6例。1例为新生儿。17例患儿进行手术治疗,叶内型手术方法为病变肺叶切除术,叶外型为单纯隔离肺叶切除。患儿术前均摄X线胸片,并行胸部CT扫描检查。结果 17例患儿行手术治疗,平均年龄5.2岁。影像学检查及增强CT扫描加血管重建检查显示异常体循环供血血管。手术证实叶内型13例,叶外型4例,均为单侧病变。除1例合并多发畸形术后死亡,其余手术病例均痊愈出院。2例未经手术治疗自动出院。随访显示所有病例恢复良好。结论小儿肺隔离症临床表现无特异性,影像学是诊断肺隔离症的有效手段,其中增强CT扫描三维重建血管成像对诊断具有重要的临床价值。手术治疗可防止发生反复肺部感染和大咯血,并可取得良好的效果。

Objective To summarize the clinical characteristics,diagnosis and treatment of pulmonary sequestration（PS） in children.Methods The clinical data of 19 children with PS confirmed by operation and（or） imaging examination from Mar.2003 to May.2008 were analyzed retrospectively.Thirteen cases were male,and 6 cases were female.One case was newborn infant.Seventeen cases received operation.Intralober type had a pulmonary lobectomy and extralobar type had a sequestrectomy.Chest X-ray and CT scan examinations were performed on the patients before operation.Results Seventeen cases got complete cure by operation,and the mean age at operation was 5.2 years.Chest enhanced CT indicated abnormal feeding arteries.Lobectomy was performed in 13 cases of intralobar PS,4 cases of extralobar PS were resected in the separated lung tissue,and all patients had unilateral lesions.No late deaths occurred in this group except 1 case who was complicated with malformation,and the postoperative follow-up showed an excellent recovery.Conclusions The main diagnostic methods of PS are CT and angiography.The diagnosis of PS can be confirmed when systemic feeding arteries are indicated on enhanced CT scans.Surgical resection is the main choice of treatment in all cases of PS in order to prevent recurrent infection and hemoptysis.The excellent results can be obtained by surgery.