成人肺隔离症的诊断与外科治疗

Diagnosis and surgical treatment of pulmonary sequestration in adults

目的探讨成人肺隔离症的诊断及外科治疗方法。方法回顾性分析我科2009年3月至2016年2月手术治疗且有明确病理学诊断的21例肺隔离症患者的临床资料。按手术方法分为开胸组(9例)和胸腔镜组(12例),统计并比较2组患者的诊断及手术情况。结果术前诊断肺隔离症8例,余13例诊断为其他疾病,误诊率为61.9%。术中发现异常血管来源于胸主动脉14例(66.7%)、腹主动脉4例(19%)、膈动脉3例(14.3%)、主动脉弓1例(4.8%)。手术证实叶内型20例(95.2%),叶外型1例(4.8%)。开胸手术组和胸腔镜组在手术时间、术中出血量、胸引管留置时间、胸腔引流量、术后住院时间上差异均无统计学意义(P=0.104、0.209、0.511、0.135、0.450)。所有患者术后恢复良好。结论肺隔离症临床表现缺乏特异性,易漏诊、误诊,胸部增强CT和血管造影是目前主要的诊断手段,开胸手术和胸腔镜手术均可取得良好的治疗效果。

Objective To explore the diagnosis and surgical treatment of pulmonary sequestration in adults. Methods Clinical data of 21 cases of puhnonary sequestration whose diagnosis was confirmed by surgical biopsy in our department from March 2009 to February 2016 were retrospectively analyzed. Divided the patients into the thoracotomy group （n=9） and the thoracoseope group （n = 12） according to different surgical methods, and compared the diagnosis and surgery of the two groups, Results Among the patients, 8 cases were diagnosed as pulmonary sequestration and the remaining 13 cases were misdiagnosed,with the misdiagnosis rate of 61.9%. Intraoperative exploration demonstrated that the abnormal blood vessels were originated from thoracic aorta （n = 14,66.7% ） ,abdominal aorta （n = 4,19% ） , phrenie artery （ n = 3,14.3% ） and aortic arch （ n = 1,4.8% ） , and there were 20 cases （95.2%） of intralobar sequestration and 1 ease （4.8%） of ex- tralobar sequestration. Patients underwent thoraeotomy and patients underwent video-assisted thoracoseopic surgery were of no significant differences in operative time （P =0. 104） ,blood loss （P =0. 209） ,chest tube duration （P =0. 511 ） ,drainage volume （P =0. 135） and postoperative hospital stay （ P =0. 450）. All the patients recovered well after surgery. Conclusion As pulmonary sequestration lacks specific clinical manifestations, missed diagnosis and misdiagnosis are very common in patients. Chest enhanced CT and CT angiography are effective diagnostic methods at present. Both thoracotomy and VATS can achieve good therapeutic effects.