13例肺隔离症诊断与治疗的临床总结

Clinical summary of the diagnosis and treatment of 13 cases of pulmonary sequestration

目的：分析13例肺隔离症（pulmonary sequestration,PS）临床特点,总结诊断和治疗经验。方法：回顾性分析本院2010年1月至2015年11月共收治的13例PS患者的临床表现、影像学特点、治疗情况和随访结果,并复习相关文献,总结诊治经验。结果：（1）临床表现：反复发作单纯咳嗽、咳痰11例,伴喘累及咯血各1例,病程3个月~12年。（2）影像学特点：所有患者的病变部位均为肺叶内型,且位于肺下叶,其中左下肺10例,右下肺3例。13例患者均接受了胸部X线检查和胸部CT平扫＋增强检查。胸部X线检查提示：肺部圆形、椭圆形团块影或分叶状或三角形阴影。胸部CT检查提示：类圆形软组织肿块影或囊液性密度影。2例螺旋CT肺血管成像（spiral CT pulmonary angiography,SCTPA）提示：患者供血动脉来源于降主动脉。（3）所有患者均行经胸腔镜手术治疗,手术顺利,术后康复出院。随访6个月~2年,1例失访,其余12例随访期间均无复发。结论：较低的发病率、临床表现缺乏特异性和临床医生较低的认识度是导致PS诊断困难的重要因素。胸部CT增强是诊断PS常规的诊断方法,SCTPA则可用于确诊。明确诊断后,可首选胸腔镜下肺叶切除术治疗。

Objective ：To summarize the experience of the diagnosis and treatment after an analysis of 13 cases of pulmonary sequestration （PS） patients. Methods ： From January 2010 to November 2015, a total of 13 cases of hospitalized patients were diagnosed as PS. Their clinical manifestations, imaging features, treatments and follow-up results were analyzed retrospectively and then related literatures were reviewed. The experience of the diagnosis and treatment were summarized. Results： （ 1 ） Clinical manifestations： 11 patients manifested as recurrent mere cough and expectoration, 1 patient was added with symptom of asthma, 1 patient was found with extra manifestation of hemoptysis. The course of disease ranged from 3 months to 12 years; （2） Imaging features：The pathological positions of all patients belonged to intralobular type and was located in the lower lobe of the lung. Among them, 10 cases located in the lower lobe of the left lung,3 cases located in lower lobe of right lung. All patients underwent chest X-ray examination and chest CT plain scan fol- lowed by enhanced scan. The chest X-ray examination showed rounded shadow,elliptic shadow,lobulated shadow,or triangular shadow in the lung. The chest CT examination showed ：rounded shadow like soft tissue or cystic fluid could be found. A sum of 2 patients under- going spiral CT pulmonary angiography （SCTPA） indicated that the blood supply was all derived from the descending aorta. （3） All patients were successfully treated with thoracoscopic lobectomy. During a follow-up duration of 6 months to 2 years, 1 case of patients was lost,and the other 12 cases had no recurrence. Conclusion：As for PS,lower incidence,nonspecific clinical manifestations and low awareness of clinicians were found as important factors which could make the diagnosis rather difficult. Chest CT enhanced scan should be a routine diagnostic method,and SCTPA would be used for ultimate diagnosis. Once diagnosed, PS should be treated with thoraco- scopic lobectomy.