肺隔离症的诊断与外科治疗  

The Diagnosis and Surgical Treatment of Pulmonary Sequestration

作　　者：林之枫[1] 居潮强[1] 黄海龙[1] 宋康生 彭寿行[1] 郑健[1] 阮征[1] 

机构地区：[1]上海交通大学附属第一人民医院胸外科,上海200080

出　　处：《中国胸心血管外科临床杂志》2010年第2期119-123,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的总结肺隔离症(pul monary sequestration,PS)的临床特征、诊断及外科手术治疗经验,以期提高对PS的诊疗水平。方法1993年8月至2007年2月我科共收治21例PS患者,其中男8例,女13例;年龄13～70岁。术前分别行胸部X线、CT、CT血管造影术(CTA)、磁共振成像(MRI)和正电子发射体层摄影CT(PET-CT)等检查;叶外型肺隔离症(ELS)行隔离肺切除术,叶内型肺隔离症(ILS)行肺叶切除术;共行左肺下叶切除术10例,右肺下叶切除术3例,左隔离肺切除术4例,右隔离肺切除术3例,行左全肺切除术1例。结果本组术后病理均明确诊断为PS,其中ELS 7例,ILS 14例;术前临床诊断为PS 7例。18例术中见有明显来自体循环的异常供血血管,其中单纯来源于胸主动脉11例,单纯来源于腹主动脉6例,另1例有2条异常血管,分别来源于胸、腹主动脉。异常血管直径为0.2～1.1 cm(平均0.7 cm),术中予双重结扎和缝扎;另有明显引流静脉3例,均经下肺静脉回流入左心房,予双重结扎。围手术期无死亡及并发症的发生。术后门诊随访20例,失访1例,随访率95.2%(20/21),随访至2009年1月,随访时间12～67个月。随访期间1例行全肺切除术患者术后2年因肺癌肝转移而死亡,其余患者情况良好。结论PS较为少见,临床症状无特异性,易误诊或漏诊;诊断方法主要为胸部X线、CT、MRI检查及选择性动脉造影;一旦确诊,大多主张外科手术治疗。Objective To summarize the clinical experiences and surgical treatment of pulmonary sequestration（PS） in order to improve the diagnosis and treatment of PS.Methods Between August 1993 and February 2007,our department enrolled 21 PS patients,8 male patients and 13 female patients,with the age ranging from 13 to 70 years old.The patients were examined by chest radiography,computerized tomography（CT）,computerized tomography angiography（CTA）,magnetic resonance imaging（MRI）,position emission tomography-CT（PET-CT） before the surgery.Sequestrectomy was performed on patients with extralobar sequestration（ELS） and lobectomy was performed on patients with intralobar sequestration（ILS）.There were 10 cases of left lower lobectomy,3 cases of right lower lobectomy,4 cases of left sequestrectomy,3 cases of right sequestrectomy and 1 case of total pneumonectomy.Results Postoperative pathology confirmed all cases of PS,including 7 cases of ELS and 14 cases of ILS.Seven patients were diagnosed to have PS by preoperative diagnostic procedures.During the surgery,we found aberrant supporting arteries from the general circulation in 18 cases among which 11 were supported by the thoracic aorta,6 by the abdominal aorta and 1 by both the thoracic and abdominal aorta.The diameter of the aberrant artery was between 0.2 cm and 1.1 cm（mean 0.7 cm）.Double ligation and transfixion were performed during the operation.In addition,we found venous drainage through the inferior pulmonary vein in 3 patients and double ligation was performed.No perioperative death or complications occurred.Follow-up was done till January 2009 on all the patients but one with a follow-up rate of 95.2%（20/21）.The follow-up time ranged from 12 to 67 months.All patients survived well except that 1 died from liver metastasis 2 years after the operation because of lung cancer.Conclusion PS is rare and its symptoms are non-specific,which can cause misdiagnosis and missed diagnosis.The diagnosis of PS mainly depends on CT,CTA,MRI and selec

关 键 词：肺隔离症 诊断 肺叶切除术 隔离肺切除术 

分 类 号：R655.3[医药卫生—外科学]