胎儿隔肌内隔离肺的诊断和治疗

Diagnosis and management of fetal intradiaphragmatic extralobar pulmoimry sequestrations

目的探讨胎儿隔肌内隔离肺的诊断和治疗。方法回顾分析我院2011年3月至2013年3月产前诊断和出生后的隔肌内隔离肺诊断和治疗经验。通过产前超声诊断和生后的CT检查以及手术确诊隔肌内隔离肺。结果在胎儿产前诊断的基础上，有45例隔离肺生后确诊并手术，其中12例（26％）为叶内型，33例（73％）为叶外型，而在叶外型中发现胸腔外的6例（18％）均为隔肌内隔离肺，无一例为腹腔型。6例隔肌内隔离肺的手术年龄为3d至18个月，平均4个月。手术除1例先经腹没找到肿瘤后改经胸腔入路外，余5例均经胸腔入路将瘤体切除。所有手术治疗均治愈，术后的病理确诊为隔离肺组织。结论产前胎儿胸腔外隔离肺以隔肌内隔离肺为主，尚不能排除腹腔内是否有隔离肺的诊断，并需要与胎儿常见的肾上腺区域肿块作鉴别。临床上治疗宜采用经胸腔隔肌切开后的瘤体切除术，手术治疗是安全可靠的。

Objective To explore the diagnosis and management of fetal intradiaphragmatic ex- tralobar pulmonary sequestrations （FIEPS）. Methods Retrospectively reviews were conducted for our experiences of fetal and pediatric bronchopulmonary sequestrations （BPS） from March 20llto March 2013 to identify the FIEPS patients. The diagnosis of FIEPS was confirmed by prenatal ultrasound, computed tomography （CT） scan and postnatal operation. Results A total of 45 BPS patients were confirmed by CT scan after birth and operated. The types of BPS were intralobar 12（26%） and ex- tralobar 33（73%）. Six （18%） patients had intra- diaphragm masses. None of the masses were within abdominal cavity. Their mean age of operation was 120 （3 - 540） days. In one case, initial abdominal approach was abandoned in favor of a thoracic approach after no finding of intraabdominal mass where- as the remaining 5 intradiaphragmatic cases were managed by a thoracic approach. All 6 patients un- derwent resection and survived. The diagnosis of FIEPS was confirmed pathologically. Conclusions FIEPS is predominantly diagnosed for prenatal extralobar pulmonary sequestration. And a proper dif- ferential diagnosis of intradiaphragmatic masses should be made for common fetal underdiaphragmatic masses. Intradiaphragmatic mass may be resected safely by thoracic and diaphragm approaches in neo- nates.