肺隔离症患者53例临床诊疗分析  

Pulmonary Sequestration: a Review of the Diagnosis and Treatment of 53 Cases

作　　者：苏娜[1] 姜鲁宁[2] 蒋胜华[2] 宋敏[1] 

机构地区：[1]济宁医学院,山东省济宁市272100 [2]济宁医学院附属医院呼吸内科,山东省济宁市272100

出　　处：《中国全科医学》2017年第36期4567-4570,共4页Chinese General Practice

基　　金：山东省医药卫生科技发展计划项目(2016WS0176)

摘　　要：背景肺隔离症是一种罕见的先天性肺发育异常疾病,临床误诊率高。目的总结肺隔离症的临床特点、影像学表现、诊断以及治疗体会,以降低误诊率。方法收集2008-01-01至2016-10-01济宁医学院附属医院收治并确诊的53例肺隔离症患者的临床资料,对其临床特点、影像学表现、诊断、治疗以及预后进行分析。结果 53例患者中,临床表现为咳嗽37例、咯血23例、咳痰20例、发热12例、胸闷8例、胸痛6例、无明显症状者9例。病变位于左下肺34例、右下肺17例、左上肺2例。影像学表现为实性肿块影19例,囊状影16例,不规则斑片状影12例,空洞4例,肺不张1例,胸腔积液1例。隔离肺的供应血管34例来源于胸降主动脉,17例来源于腹主动脉,1例来源于胸主动脉和膈肌动脉,1例来源于腹主动脉和左膈上动脉。53例患者确诊30例,23例出现误诊,误诊率为43.4%;48例行胸腔镜下肺叶切除术,术后继发肺部感染1例,2例咯血患者行异常动脉介入栓塞治疗,余3例行对症治疗。所有手术患者未再复发。结论肺隔离症临床表现无特异性,误诊率高,增强CT和CT血管造影(CTA)是临床常用的诊断方法,确诊后应积极手术,胸腔镜下肺叶切除术是临床最有效的治疗方法。Background Pulmonary sequestration is a rare congenital pulmonary malformation with high rate of misdiagnosis. Objective To summarize the clinical features, imaging findings, diagnosis and treatment of pulmonary sequestration,in order to decrease the misdiagnosis rate of this disease. Methods We collected the clinical data of 53 pulmonary sequestration patients who were diagnosed and treated in Affiliated Hospital of Jining Medical University from January 1,2008 to October 1,2016 and analyzed their clinical features, imaging findings, diagnosis, treatment and prognosis. Results The clinical manifestations of these patients were cough（ 37 cases）,hemoptysis（ 23 cases）,expectoration（ 20 cases）,fever（ 12 cases）,chest tightness（ 8 cases）,chest pain（ 6 cases）,non-obvious symptoms（ 9 cases）. The lesions were located in the left lower lung in 34 cases,in the right lower lung in 17 cases,and in the left upper lung in 2 cases. Imaging showed solid mass in 19 cases,cystic shadow in 16 cases,irregular patchy shadow in 12 cases,cavity in 4 cases,atelectasis in 1 case,pleural effusion in 1 case. The anomalous arteries supplying blood to bronchopulmonary sequestration were found from descending thoracic aorta in 34 cases,from abdominal aorta in 17 cases,from thoracic aorta and diaphragm artery in 1 case and from abdominal aorta and left superior phrenic artery in 1 case. Thirty cases were diagnosed confirmedly but 23 cases were misdiagnosed, the misdiagnosis rate was 43. 4%. Three cases received symptomatic treatment,the other 48 cases received thoracoscopic lobectomy,of whom 1 had postoperative lung infection,and 2 received abnormal arterial embolization due to hemoptysis. No recurrence was found in all surgical patients. Conclusion Pulmonary sequestration has high misdiagnose rate due to its atypical clinical manifestations. Enhanced CT and CTA are frequently used to help the diagnosis. When the patient is diagnosed confirmedly,surgery should be performed as early as possible. Thoracoscopic lobecto

关 键 词：支气管肺隔离症 体征和症状 诊断 治疗 

分 类 号：R562.2[医药卫生—呼吸系统]