55例肺隔离症患者的临床诊治分析

Diagnosis and treatment of 55patients with pulmonary sequestration

目的总结肺隔离症临床特点,提高肺隔离症的诊疗水平。方法回顾性分析2011年1月至2017年12月中南大学湘雅二医院收治并确诊的55例肺隔离症患者的临床资料。结果55例肺隔离症患者中男24例,女31例,平均年龄(37±19)岁,平均病程超过4年;主要症状为咳嗽、咳痰、咯血、发热,16.36%的患者无显著临床症状;其中叶内型52例,叶外型3例,病变主要位于下叶。55例患者误诊率高达41.82%;其中38例患者接受了手术切除,电视胸腔镜辅助手术患者术后平均住院时间为(5.28±1.25)d,开胸手术患者术后平均住院时间为(6.29±2.32)d,差异无统计学意义(t=-1.099,P=0.279)。术后均无严重并发症,无死亡病例。结论肺隔离症临床表现无特异性,误诊率高。肺部增强CT和CT血管造影是临床确诊肺隔离症常用的非侵袭性技术。发现异常的动脉供血血管是肺隔离症诊断的关键。手术切除仍是该症首选的治疗方法,其中电视胸腔镜辅助手术和开胸手术的比较分析仍有待进一步的研究。

Objective To summarize the characteristics of pulmonary sequestration ( PS) and to improve the level of diagnosis and treatment of PS .Methods The clinical data of 55 patients with PS diagnosed in the Second Xiangya Hospital of Central South University from January 2011 to December 2017 were retrospectively analysed .Results 55 patients with PS included 24 males and 31 females with an average age of ( 37 ± 19) years old ,and the average course of illness was over four years .The main symptoms of these patients included cough ,sputum ,hemoptysis ,and fever .16 .36% of the patients had no obvious clinical symptoms .Of the 55 patients ,52 were diagnosed with intralobar pulmonary sequestration and three had extralobar pulmonary sequestration . The misdiagnosis rate was 41 .82% . Thirty-eight patients underwent surgery .The length of postoperative hospital stay for patients with video-assisted thoracic surgery and posterolateral thoracotomy was ( 5 .28 ± 1 .25) days and (6 .29 ± 2 .32) days ,there was no statistical difference ( t = -1 .099 , P = 0 .279) .There were no serious complications after surgery and no deaths .Conclusions The misdiagnosis rate of PS is high due to its non-specific clinical manifestations .Noninvasive techniques such as lung enhanced CT and CT angiography are commonly used to make diagnosis .Founding abnormal arterial blood vessels is the key to the diagnosis of PS .Surgical resection is still the effective treatment of the disease ,of which the comparative analysis of video-assisted thoracic surgery and thoracotomy remains to be further studied .