肺隔离症的诊断及不同外科治疗方法的效果比较

Diagnosis of pulmonary sequestration and comparison of surgical treatment

目的探讨肺隔离症的诊断方法,并比较传统开胸手术与胸腔镜手术的疗效。方法收集2009年10月至2016年1月在天津医科大学总医院收治并同意行手术治疗的18例患者临床资料,其中7例行胸腔镜手术,11例行开胸手术。比较两组患者的平均年龄、手术时间、术中出血量、术后引流量、术后引流天数、有无术后并发症、术后住院天数以及总住院费用。结果胸腔镜组术后平均引流时间和住院时间均短于开胸组,差异有统计学意义(t=4.553,P<0.05;t=5.068;P<0.05)。但两组患者的平均年龄、手术时间、术中出血量和总住院费用比较,差异均无统计学意义(P>0.05)。诊断主要依靠胸部影像学诊断,特别是胸部增强CT及三维重建血管成像,能够发现异常动脉血管影;尤其是多排螺旋CT扫描更能明显减少三维重建产生的伪影,使图像更接近于真实,再结合患者既往病史即可初步诊断。结论胸腔镜治疗肺隔离症安全、可靠,术后恢复快、伤口美观,值得推广和应用。

Objective To investigate the diagnosis of pulmonary sequestration, and compare thetherapeutic effects between open chest surgery and thoracoscopic surgery for pulm Methods The clinical data of 18 patients with pulmonary sequestration undergoing surgical treatments in Tianjin Medical University General Hospital between October 2009 and January 2016 wereretrospectively analyzed, including 7 cases of thoracoscopicsurgery and 11 cases of open surgery. The mean age , operation time , volume of intraoperative blood loss , time of postoperative drainage , volume of postoperative drainage , occurrence of postoperative complications , postoperative hospitalization time and totd hospitalization expenses were compared between two groups. Results The mean time ofpostoperative drainage and hospitalization in thoracoscopic surgery group was signithat in open chest surgery group（t= 4.553, P〈0.05; t=5.068,P 〈 0.05）. However, there was nosignificant difference in mean age, operation time, volume of intraoperative blood loss and totalhospitalization expenses between l：wo groups （P 〉 0.05 ）. The diagnosis was mainly based on chestimaging diagnosis, especially chett enhanced CT and three-dimensional reconstruction of blood vesselimaging, which revealed abnormal arteries. In particular, multi-slice spiral CT scan significantly reduced the artifacts of thre-dimensional reconstruction,which made the image closer to reality. Then, the preliminary diagnosis was formed on the basis of previous disease history. Conclusions Thoracoscopic surgereliable to treat pulmonary sequestration with thoracoscopic surgery, which is worthy of widely application.