43例成人肺内型肺隔离症影像学特征及手术治疗效果分析  

Imaging findings and surgical results of intralobar pulmonary sequestration in 43adults

作　　者：董冠中[1] 周振强 刘青锋[1] 赵璞[1] 何苡[1] DONG Guanzhong;ZHOU Zhenqiang;LIU Qingfeng;ZHAO Pu;HE Yi(Department of Thoracic Surgery,Henan Provincial People's Hospital,Zhengzhou450003,China)

机构地区：[1]河南省人民医院胸外科,郑州450003

出　　处：《中华实用诊断与治疗杂志》2020年第5期474-476,共3页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省医学科技攻关项目(201503180)。

摘　　要：目的总结成人肺内型肺隔离症的影像特征及手术治疗效果。方法回顾性分析43例成人肺内型肺隔离症患者的术前X线胸片、胸部增强CT、CT血管造影资料及手术治疗疗效。结果20例术前行X线胸片检查,示肺叶病变部位肿块、轮廓清晰,诊断肺内型肺隔离症5例(25.0%),误诊为肺囊肿10例、支气管扩张症5例。43例术前行胸部增强CT扫描,示病变位于右肺上叶1例、左肺下叶基底段23例、右肺下叶基底段19例;异常供血动脉来源于胸主动脉26例、腹主动脉14例、肋间动脉2例、无异常动脉供血1例;肺叶病变部位团片状影,密度不均匀,内可见囊状低密度影及多发血管影;诊断肺内型肺隔离症25例(58.1%),误诊为肺囊肿15例、原发性肺癌3例。35例术前行CT血管造影,可见供应病变部位的异常起源单支或多支血管;诊断肺内型肺隔离症26例(74.3%),误诊为原发性肺癌5例、支气管扩张症4例。43例均行电视胸腔镜下肺叶切除术,术后无并发症发生,均治愈出院。出院后随访13~65个月,4例失访,余患者均未复发。结论肺内型肺隔离症易误诊,胸部增强CT扫描及CT血管造影有助于其诊断,电视胸腔镜下肺叶切除术治疗效果确切。Objective To investigate the imaging features of intralobar pulmonary sequestration and the surgical results in adults.Methods The chest X-ray film,chest enhanced CT scan and CT angiography results before operation as well as the surgical results were retrospectively analyzed.Results The X-ray film of 20patients showed the clear contour of intralobal lesion.In these 20patients,5(25.0%)were correctly diagnosed,and the other 15were misdiagnosed as pulmonary cysts in 10and bronchiectasis in 5.Chest enhanced CT scan of 43patients showed lesions in the upper lobe of right lung in 1case,at the basal segment of lower lobe of left lung in 23,and at basal segment of lower lobe of right lung in 19;abnormal blood supply from the thoracic aorta in 26patients,from the abdominal aorta in 14and from intercostals artery in 2,and no abnormal blood supply in 1;enhanced CT showed patchy pulmonary lobe lesions with uneven density,cystic low density shadow and multiple vascular shadow;25(58.1%)were correctly diagnosed,and the other 18patients were misdiagnosed as pulmonary cyst in 15and primary lung cancer in 3.CT angiography was performed in 35patients before operation,showing abnormal blood supply from single or multiple blood vessels,in which 26patients(74.3%)were correctly diagnosed,and the other 9patients were misdiagnosed as primary lung cancer in 5and bronchiectasis in 4.Forty-three patients were discharged with no postoperative complications after video-assisted thoracoscopic surgery.All patients were followed up for 13to 65months and were found no recurrence except 4patients were lost.Conclusion Intralobar pulmonary sequestration is easily to be misdiagnosed.Chest enhanced CT scan and CT angiography are helpful for its diagnosis,and video-assisted thoracoscopic surgery is definitely effective.

关 键 词：肺隔离症 肺内型 电视胸腔镜 肺叶切除术 X线胸片 增强CT扫描 CT血管造影 

分 类 号：R655.3[医药卫生—外科学]