肺隔离症诊治:53例分析

Diagnosis and Treatment of Pulmonary Sequestration:Report of 53 Cases

目的通过对53例肺隔离症病例的分析,以期达到临床医生对这一临床少见病的进一步认识,减少误诊、误治的发生率。方法回顾性分析北京协和医院1988年至2009年收治的53例肺隔离症患者的临床特征、诊治过程及其远期疗效。结果 53例患者中男29例,女24例;年龄12～68岁,平均年龄32.7岁;病程1周到40年,平均68个月。40例术前诊断为肺隔离症,7例诊断为肺囊肿,3例诊断为支气管扩张,1例诊断为肺大疱,1例诊断为胸腔积液待查,1例诊断为肺癌。所有患者均进行了手术治疗,50例采用开胸探查,3例采用胸腔镜手术。术后病理均符合肺隔离症。53例患者中46例获得随访,随访时间平均8年,均无远期并发症发生。结论肺隔离症是一种少见的肺部先天性畸形,增强CT+三维重建是肺隔离症诊断的最佳辅助手段,因其可引起感染、咳血,甚至发生癌变,一经诊断,推荐手术治疗,开胸手术或胸腔镜微创手术均可取得良好的治疗效果。

Objective To analyze the clinical features of pulmonary sequestration,with an attempt to improve the understanding of this disease and minimize diagnosis and treatment errors.Methods The clinical data including the clinical features,diagnostic methods,operative technique,complications,and outcomes of 53 patients with pulmonary sequestration from 1988 to 2009 were retrospectively reviewed.Results Of these 53 patients,there were 29 males and 24 females aged 12-68 years（mean：32.7 years）.Their disease course ranged from 1 week to 40 years（mean：68 months）.Preoperative diagnoses included pulmonary sequestration（n=40）,pulmonary cyst（n=7）,bronchiectasis（n=3）,bullae（n=1）,hydrothorax（n=1）,and lung cancer（n=1）.Thoracotomy was performed in 50 patients and thoracoscopy was performed in 3 patients.Pulmonary sequestration was pathologically confirmed in all 53 patients.Follow-up（mean：8 years）was performed in 46 patients,and no long-term complication was noted.Conclusions Pulmonary sequestration is rare pulmonary congenital deformity.Enhanced computed tomography and three-dimensional reconstruction are most helpful for diagnosis.Surgery is preferred,and both thoracotomy and thoracosopy can achieve good outcomes among selected patients.