中叶综合征的外科治疗(附80例报告)

Surgical therapy of middle lobe syndrome: A report of 80 cases

目的探讨中叶综合征的临床特征及外科治疗方法。方法回顾性分析1996年6月-2010年8月收治的80例经手术及病理证实的中叶综合征患者的临床资料。结果 80例患者中男47例,女33例,年龄5～81岁,平均54.5岁。无症状体检发现者28例,有临床症状者52例,咳嗽、咳痰、发热、胸痛、咯血为临床五大症状。胸部X线片显示右心缘模糊或呈三角形肺不张阴影,胸部增强CT扫描部分病例可见中叶根部肿大淋巴结影像及右中叶支气管内肿物,纤维支气管镜检查阳性率达46.6%(21/45)。全组均行手术治疗,其中单纯中叶切除者47例(58.8%),联合肺叶切除者28例(35%,包括袖状切除4例),全肺切除者1例(1.2%),中叶部分切除者4例(5%)。术后均顺利恢复,无手术死亡病例。结论中叶综合征临床表现无特异性,纤维支气管镜检查应列为常规检查。手术切除是中叶综合征的最佳治疗方案。

Objective To explore the clinical manifestation and surgical treatment of the middle lobe syndrome.Methods A total of 80 patients with middle lobe syndrome,received and cured from June 1996 to August 2010 and conformed by pathological studies,were made to undergo retrospective analysis.Results Among the 80 cases（47 males and 33 females,aged 5 to 81 years with an average age of 54.5 years） of middle lobe syndrome,52 cases showed five big clinic symptoms that include cough,expectoration,fever,chest pain,or hemoptysis,whereas 28 cases showed no symptoms.The chest x-ray result showed that the right heart edge appeared fuzzy or atelectasis triangle appeared shadowy.The chest enhanced CT scan showed swollen lymph nodes at the root of the middle lobe,and tumors could be detected in the lumen of right middle lobe bronchus.The positive rate of fiber-optic bronchoscopy was 46.6%（21/45）.The surgical procedures included simple lobectomy in 47 cases（58.8%）,bilobectomy in 28 cases（35%,including sleeve resection of four cases）,right pneumonectomy in one case（1.2%）,and partial resection in four cases（5%）.Successful operation had been achieved in all the cases,and no occurrence of death was noted.Conclusions The clinical manifestations of the middle lobe syndrome are non-specific.Fiber-optic bronchoscopy should be listed as a routine examination.The best treatment for the middle lobe syndrome is to perform a surgery.