小儿先天性肺隔离症的诊断与治疗  

The diagnosis and treatment of congenital pulmonary sequestration in children

作　　者：张鸿毅[1] 杨志刚[1] 张德重[1] 

机构地区：[1]山西省儿童医院心胸外科,太原030013

出　　处：《中华小儿外科杂志》2012年第9期688-691,共4页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨小儿先天性肺隔离症的诊断与治疗。方法回顾性分析2001年3月至2011年3月收治的小儿先天性肺隔离症20例的临床资料。其中，男11例，女9例，年龄4d～9岁（平均5．3岁），体重4～28kg（平均11．3kg）。术前20例均行x线平片检查，15例加行普通CT平扫检查。误诊为肺囊肿9例，肺内肿瘤2例，漏诊4例在行其他手术时发现本病；另5例加行64层高速螺旋CT三维血管成像检查，发现有异常体动脉分支血管入隔离肺组织4例，高度疑诊本病1例。结果全部2（）例均接受手术治疗，术后病理检查均证实为本病。术中发现病变肺组织（隔离肺）均有起自体动脉分支血管供血。本组均治愈，术后随访15例，随访2～7年，生长发育良好无复发，失访5例。结论本病较少见，临床表现缺乏特异性，易被误诊和漏诊。高速螺旋CT三维血管成像检查是术前确诊本病的重要手段。术中准确处理来自体动脉的分支血管是手术成功的关键。Objective To explore the diagnosis and treatment of congenital pulmonary sequestration in children. Methods Between March 2001 and March 2011, total 20 children with congenital pulmonary sequestration underwent treatment in our center, in which 11 were male and 9 were female. Their average ages was 5. 3 years （ranging from 4 days to 9 years old） and mean weight was ~1.3 kg （ranging from 4 to 28 kg）. Their clinical data were reviewed in this study. All cases were examined by chest radiography, and 15 cases of them were further examined by CT. 9 cases were misdiagnosed as lung cyst, 2 cases as lung tumor, 4 cases missed diagnosis and confirmed during surgery. Other 5 cases were examined by 64-slice spiral CT angiography combined three dimensional reconstruction. Abnormal feeding arteries were discovered in 4 case of them and 1 case was highly suspected. Results All cases underwent surgery successfully and postoperative pathology confirmed of pulmonary sequestration. During the operation, we found aberrant supporting arteries from the general circulation to pulmonary sequestration. All cases recover well without recurrence. Conclusions Pulmonary sequestration is rare Their symptoms are non-specific characteristic and are easily to be misdiagnosed or miss diagnosis. Spiral CT angiography combined three dimensional reconstruction is effective way for pre- operative diagnosis. The key of surgery is to ligate and cut the supporting arteries from general circulation accurately.

关 键 词：支气管肺隔离症 诊断 外科手术 

分 类 号：R72[医药卫生—儿科] R726[医药卫生—临床医学]