38例肺隔离症的诊断及外科治疗

Diagnosis and surgical treatment of 38 cases of pulmonary sequestration

目的 总结肺隔离症的诊断及外科治疗体会.方法 回顾性分析我院心胸外科自1983年1月至2009年1月的38例肺隔离症患者的临床资料及外科治疗方式.其中术前诊断肺隔离症15例（40%）,误诊为肺癌12例（31%）,支气管扩张症8例（21%）,肺囊肿3例（8%）.结果 38例患者均行手术切除,术后病检证实为肺隔离症.叶内型30例（79%）,叶外型8例（21%）.异常血管源于胸主动脉28例（73%）,源于腹主动脉6例（16%）,肋间动脉3例（8%）,胸廓内动脉1例（3%）.无手术死亡病例.结论 肺隔离症是一种少见的先天性肺发育畸形,容易反复发生肺部感染、咯血.误诊率高,一经发现应尽早手术切除,手术过程中需注意异常肺血管的处理.

Objective To summarize the experience in surgical treatment and diagnosis of 38 cases of pulmonary sequestration. Methods We performed an retrospectively analysis on clinical data and surgical treatment of 38 cases of pulmonary sequestration operated at the Department of Cardiothoraeic Surgery,Tongji Hospital between January 1983 and January 2009. Before operation, pulmonary sequestration was diagnosed in 15 cases （40%）,lung cancer in 12 （31%）, bronehieetasis in 8 （21%）, and lung cyst in 3 （ 8% ）. Results All cases received surgical operation successfully and pulmonary sequestration was confirmed pathologically. There were 30 eases of intralobar sequestration （79%） and 8 cases of extralobar sequestration （21% ）. Anomalous artery from the systemic circulation was found in all patients： from thoracic aorta in 28 （73%） ,abdominal aorta in 6 （16%） ,intercostal artery in 3 （8%） ,and internal mammary artery in 1 （3%）. Conclusion Pulmonary sequestration is a rare congenital malformation of lung suffered from recurrent pulmonary infections and hemoptysis with higher rate of misdiagnosis. Surgical management as early as possible is recommended. To deal with the aberrant artery is the key procedure.