成年人肺隔离症的临床诊断及治疗

目的探讨成年人肺隔离症的发生与分型及诊疗方法，以期减少误诊率，提高外科治疗水平。方法回顾性分析经手术治疗证实的17N肺隔离症患者临床资料。结果17例患者中男性6例，女性11例，年龄27-63岁，平均40岁。反复咳嗽、咯白色黏痰或脓痰11例，咯血2例，伴间歇发热2例，胸痛1例，无症状1例，术前误诊肺囊肿6例、肺脓肿1例、肺癌1例、肺炎性假瘤2例、纵隔肿瘤1例，误诊率64．7％（11／17）。17例均为叶内型，均行病变肺叶切除术，1例出现术中大出血，其余患者手术顺利，术后病理均诊断为肺隔离症。无术后并发症，无围手术期死亡病例。结论成人肺隔离症的误诊率较高，主要通过X线、CT及主动脉逆行造影等检查诊断，近几年螺旋CT增强扫描三维重建可显示异常供血动脉及引流静脉，是诊断肺隔离症的首选检查方法。

Objective To Summary the occurrence of adults with pulmonary sequestration broad analysis and classification, clinical diagnosis, treatment and prognosis, and to explore the methods of diagnosis and treatment of pulmonary sequestration in order to reduce the misdiagnosis rate, raise the level of surgical treatment. Methods Retrospective analysis was carried out for the clinical data of 17 cases of patients with pulmonary sequestration in the surgical treatment of the hospital in February 2002 to February 2012. Results In this group of 17 patients, 6 male patients, 11 females; aged 27 to 63 years old, mean age 40 years. In this group, 11 cases have repeated coughing, slightly white phlegm or purulent sputum, two cases of hemoptysis, two cases with intermittent fever, one cases of chest pain, one cases of asymptomatic. Before surgery pulmonary sequestration were misdiagnosed as lung cyst （ 6 case ） ; lung abscess （ 1 cases ） ;lung cancer （ 1 cases ） ; inflammatory pseudotumor （ 2 cases ） ;lung cancer （ 1 case ） , the misdiagnosis rate of 64.7% （ 11/17 ） . The main examination methods in imaging diagnosis, they are all intralobuIar type, pathological examination are clear for pulmonary sequestration, lpatient got massive hemorrhage insurgieal operation, Success of pulmonary lobectomy had been aehieved in all cases without any death during the operation or postoperatively complication. Conclusions The higher rate of misdiagnosis of adult with pulmonary sequestration, the diagnosis through a combination of X-ray, CT, and aortic retrograde pyelography examination data, in recent years 3D reconstruction with enhanced spiral CT can depict anomalous systemic artery and drainage vein and it is the first method of choice in diagnosing pulmonary sequestration.And by this methods can significantly reduce the misdiagnosis rate.