23例肺隔离症临床病理学特征及诊疗分析  

Clinicopathological characteristics of 23 cases of pulmonary sequestration and its diagnosis and treatment

作　　者：张伟[1] 何建军[1] 许静[2] 张慧敏[1] 李晓 ZHANG Wei;HE Jian-jun;XU Jing;ZHANG Hui-min;LI Xiao(Department of Breast Surgery,The First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China;Department of Geriatric Endocrinology,The First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China)

机构地区：[1]西安交通大学第一附属医院乳腺外科,陕西西安710061 [2]西安交通大学第一附属医院老年内分泌科,陕西西安710061

出　　处：《西安交通大学学报（医学版）》2018年第5期738-742,共5页Journal of Xi’an Jiaotong University（Medical Sciences）

基　　金：西安交通大学第一附属医院院基金资助项目(No.2017QN-16);陕西省重点研发计划(No.2018SF-156)~~

摘　　要：目的先天性肺畸形疾病肺隔离症(pulmonary sequestration,PS)由于临床特征不明显容易被误诊,应加强研究其临床特点,以提高手术前正确诊断机会并总结经验。方法对西安交通大学第一附属医院2000年-2014年间收治的23例PS患者进行回顾性分析,包括性别、年龄、就诊时间、症状、隔离部位、术前检查、动脉供应、静脉回流、术前误诊、治疗、病理检查和预后。结果男性∶女性比为1.09∶1。年龄1~62岁,平均(36.78±15.58)岁。男性中位就诊时间间隔长于女性(51.05个月vs.35.70个月)。主要症状为慢性/复发性肺炎,13.04%的患者无症状。疾病位于左后基底段(73.91%)、右后基底段(17.39%)、右中叶(8.70%)。胸部CT表现为肿块性病变(52.38%)和囊性病变(23.81%)。动脉供应主要由胸主动脉分支(84.62%)提供。术前误诊率平均为43.83%。69.57%(16例)行手术治疗,56.25%(9例)行肺叶切除。长期随访示患者健康状况良好。结论 PS容易误诊。可能由于症状的非特异性而导致男性就诊时间间隔更长。仔细分析症状和有效的影像检查能提高术前诊断的正确率。Objective Pulmonary sequestration(PS)is a congenital lung malformation that is often misdiagnosed due to the lack of obvious clinical characteristics.Therefore,it is necessary to strengthen research on the clinical characteristics of PS so as to improve the chances of a correct diagnosis before surgery.Methods We made a retrospective analysis of 23 PS patients treated in The First Affiliated Hospital of Xi'an Jiaotong University from the year 2000 to 2014.The following data were analyzed:age,sex,time of diagnosis,symptoms,isolated body parts,preoperative examination,arterial supply,venous drainage,preoperative misdiagnosis,treatment,pathological examination,and prognosis.Results The male∶female ratio was 1.09∶1 and the mean age was 36.78±15.58(range of 1-62 years).The median time interval of the males was longer than that of females(51.05 months vs.35.70 months).Major symptoms were chronic/recurrent pneumonia,and 13.04%of the patients were asymptomatic.The sequestration was located in the left posterior basal segment(73.91%of cases),right posterior basal segment(17.39%).and right median lobe(8.70%).CT of the chest showed mass lesions(52.38%)and cystic lesions(23.81%).The arterial supply was provided mainly by branches of the thoracic aorta(84.62%).Mean prevalence of preoperative misdiagnosis was 43.83%.Surgery treatment was underwent in 16(69.57%)patients and lobectomy was undertaken in 9 patients(56.25%).Long-term follow-up revealed that the patients who had been asymptomatic were in good health.Conclusion PS can be easily misdiagnosed,which may be that the treatment-seeking time interval of male patients is longer due to the nonspecific symptoms.Careful analysis of symptoms and effective imaging examinations can improve the chances of a correct preoperative diagnosis.

关 键 词：肺隔离症 影像学 异常血管供应 误诊 肺叶切除术 就诊延迟 

分 类 号：R56[医药卫生—呼吸系统]