肺隔离症18例报告  

Pulmonary Sequestration——Report of 18 Cases

作　　者：王恩桐[1] 安若昆[1] 赵福元[1] 于刚毅[1] 

机构地区：[1]天津市胸科医院

出　　处：《天津医药》1989年第12期717-720,共4页Tianjin Medical Journal

摘　　要：本文报告18例肺隔离症,男性稍多,中青年多见,平均年龄25.8岁,平均病程13.3年,叶内型16例,叶外型2例,均有源于体循环之异常动脉,其中1例多至6支,另1例伴有一支1.5cm 粗大静脉引流至膈肌(一般引流至下肺静脉),皆为国内外文献中所少见。X 线胸片表现大多数为下叶后基底段之单发或多发囊性病变,2/3在左下叶,只1例位于舌叶,2例叶外型病变呈团块状。10例(56%)术前误诊:6例误为肺囊肿,2例误为枝扩,1例误为肺癌,另1例误为肺大泡。故本文重点讨论了诊断和鉴别诊断。关于手术治疗,叶内型多行肺叶切除,叶外型行肺段或隔离病变切除。手术时小心分离粘连,看清异常血管,并应常规在下肺韧带内外侧寻找异常血管,先结扎,后切断,以防血管回缩或滑脱。Eighteen cases of pulmonary sequestration were reported.It showed some pre-ponderance in male and occured mostly in adolescence and young adults.The meanage was 25.8 yrs.And mean duration was 13.3 yrs.Sixteen cases were of intralobartype and 2 cases of extralobar type.Anomalous artery from the systemic circula-tion was discovered in all cases.One case derived its blood supply from 6 anoma-luos arteries and another case was discovered to be accompanied by a large vein(15 mm in diameter)draining to the diaphragm(usually venous drainage to theinferior pulmonary vein).Those 2 findings were very rare in the literature.Roent-genograph of the chest showed mostly a single or multiple cystic lesion on theposterior basilar segment of the lower lobes.Two thirds of them were located onthe left side.Only one lesion was situated in the lingular lobe.Lesions of the 2cases of the extralobar type appeared as a solid mass on X-ray film.Ten cases(56%)were misdiagnosed before operation:6 cases as pulmonary cyst,2 as ron-chiectasis,one as bronchogenic carcinoma and another one as pulmonary bulla.Thediagnosis and differential diagnosis were disscussed.As to the surgical treatment,lobectomy was the treatment of choice for intralobar type and segment resection ofthe sequestration was indicated for the extralobar type.Cautions freeing up of in-flammatory adhesions permits adequate visualization of the anomalous vessels so thatligation can be performed.Exposure of anomalous vessels on the medial and lateralaspects of the inferior pulmonary ligament routinely,was essential secure ligationmust be done before division in order to avoid retraction of the vessels.

关 键 词：肺隔离症 肺畸形 诊断 

分 类 号：R655.304[医药卫生—外科学]