成人肺隔离症危险因素和手术结果的临床研究  

Clinical study on risk factors and surgical results of pulmonary sequestration in adults

作　　者：杨伟光 易呈祥 张鹏[1] 戴洁[1] YANG Weiguang;YI Chengxiang;ZHANG Peng;DAI Jie(Department of Thoracic Surgery,Shanghai Pulmonary Hospital,Tongji University School of Medicine,Shanghai 200433,China)

机构地区：[1]同济大学医学院/同济大学附属上海市肺科医院胸外科,上海200433

出　　处：《空军军医大学学报》2024年第10期1178-1183,1190,共7页Journal of Air Force Medical University

基　　金：国家自然科学基金(81802260)。

摘　　要：目的探讨肺隔离症(PS)的术前诊断和术后并发症发生的危险因素。方法对2013年6月至2022年12月在同济大学附属上海市肺科医院接受PS手术治疗的成人患者进行回顾性分析。使用logistic回归分析识别PS术前诊断和术后并发症的危险因素。结果共纳入97例患者,术前误诊率为38.1%(37/97),最常见的误诊疾病是肺部肿瘤/结节(23/37,62.2%)。59.0%的PS患者同时伴反复呼吸道或左下肺固定部位感染史。无症状表现、实性肿块和叶外型肺隔离症(ELS)是PS术前诊断的独立危险因素。与术前确诊组相比,误诊组的手术时间(120.8 min vs 109.0 min,P=0.038)、术中失血量(196.5 mL vs 108.3 mL,P=0.005)和术后并发症(21.6%vs 5.0%,P=0.019)显著增加。术后并发症发生率为11.3%(11/97),包括4例输血、3例肺炎、3例心律失常和1例漏气。多因素logistic回归分析显示,术前误诊和开胸手术是PS术后并发症的独立危险因素。结论无症状表现、实性肿块和ELS是PS患者术前诊断的独立危险因素。术前误诊和开胸手术是PS术后并发症发生的独立危险因素。临床医生在诊断脊柱附近肺下叶的无症状实性肿块时,若患者同时伴反复呼吸道或左下肺固定部位感染史,应高度怀疑PS,术前使用造影检查找异常动脉以确认诊断。微创手术治疗PS安全有效。Objective To investigate the risk factors of preoperative diagnosis and postoperative complications of pulmonary sequestration(PS).Methods A retrospective analysis was performed on adult patients who received surgical treatment for PS in Shanghai Pulmonary Hospital from June 2013 to December 2022.Logistic regression analysis was applied to identify risk factors for preoperative diagnosis and postoperative complications of PS.Results A total of 97 patients were included,the preoperative misdiagnosis rate was 38.1%(37/97),and the most common misdiagnosed disease was lung tumor/nodule(23/37,62.2%).Nearly 59.0%of PS patients also had a history of recurrent respiratory infections or persistent infections at a fixed location in the left lower lung.Asymptomatic presentation,solid mass,and extralobar sequestration(ELS)were independent risk factors for preoperative diagnosis of PS.Compared with the preoperative confirmed group,the operation time(120.8 min vs 109.0 min,P=0.038),intraoperative blood loss(196.5 mL vs 108.3 mL,P=0.005),and postoperative complications(21.6%vs 5.0%,P=0.019)were significantly increased in the misdiagnosis group.The postoperative complication rate was 11.3%(11/97),including 4 cases of transfusions,3 cases of pneumonia,3 cases of arrhythmias,and 1 case of air leakage.Multivariate logistic regression analysis showed that preoperative misdiagnosis and thoracotomy were independent risk factors for postoperative complications of PS.Conclusion Asymptomatic presentation,solid mass,and ELS are independent risk factors for preoperative diagnosis of PS patients.Preoperative misdiagnosis and thoracotomy are independent risk factors for postoperative complications in PS.Clinicians should highly suspect PS when diagnosing asymptomatic solid masses near the spine in the lower lobes of the lung,especially if the patient has a history of recurrent respiratory infections or persistent infections at a fixed location in the left lower lung.Preoperative use of contrast examination to identify abnormal arteries is re

关 键 词：肺隔离症 术前诊断 术后并发症 危险因素 胸腔镜手术 

分 类 号：R655[医药卫生—外科学]