经动脉栓塞治疗新生儿肺隔离症16例

Transarterial embolization for the treatment of pulmonary sequestration in newborn infants: initial experience in 16 cases

目的 评价经动脉栓塞治疗新生儿肺隔离症的安全性和长期临床疗效.方法 2005年5月—2012年12月,收治16例经CT确诊的肺隔离症新生儿,接受血管内弹簧圈栓塞治疗.结果 所有患儿均成功接受了弹簧圈栓塞治疗.l例术中由于弹簧圈脱落而进入右股动脉,经溶栓后,未出现右下肢缺血症状.该弹簧圈在术后3d取出.16例术后均未出现感染、栓塞后综合征及胸腔积液等并发症.术后即刻造影显示14例患儿供血动脉完全栓塞,2例不完全栓塞,完全栓塞率为87.5％ （95％CI：69％、106％）.随访时间12～ 90个月,平均（47±23）个月,所有患儿完全康复,随访过程中均未出现肺隔离症相关的临床症状.末次CT随访显示15例患儿（93.8％）病灶完全消失,1例明显缩小,未出现病灶增大现象.结论 经动脉弹簧圈栓塞治疗新生儿肺隔离症安全而远期疗效仍佳.

Objective To evaluate the safety and long-term clinical efficacy of transarterial embolization with coils in treating pulmonary sequestration in newborn infants.Methods From May 2005 to December 2012,sixteen newborn infants with CT-proved pulmonary sequestration were admitted to authors＇ hospital to receive endovascular embolization with coils.Results Coil embolization was successfully performed in all patients.In one infant patient the coil fell off and got into the right femoral artery during embolization procedure,but no ischemic symptoms of the right leg occurred after thrombolysis with urokinase.Three days later the dropped coil was successfully removed.After the treatment no infection,post-embolization syndrome or thoracic effusion was observed in all the 16 infant patients.Angiography performed immediately after the procedure showed that complete obstruction of the feeding artery was obtained in 14 cases and incomplete obstruction of the feeding artery in two cases,with a complete embolization rate of 87.5% （95% confidence interval：69%,106%）.All patients were followed up for 12-90 months with a mean of （47 ± 23） months.Complete recovery was obtained in all patients.During the follow-up period no sequestration-related clinical symptoms occurred.The last CT scanning showed that complete disappearance of the lesion was seen in 15 patients （93.8%） and obvious shrinkage of the lesion in one.Conclusion For pulmonary sequestration in newborn infants,transarterial embolization with coils is a very safe procedure with excellent long-term clinical efficacy.