Gezer Suat, Taştepe Irfan, Sirmali Mehmet, Findik Göktürk, Türüt Hasan, Kaya Sadi, Karaoğlanoğlu Nurettin, Cetin Güven
Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Clinic of Thoracic Surgery, Ankara, Turkey.
J Thorac Cardiovasc Surg. 2007 Apr;133(4):955-9. doi: 10.1016/j.jtcvs.2006.11.003.
Large series about pulmonary sequestration from a single institute are rare in the literature. In this study, we aimed to evaluate diagnosis, treatment, and outcomes of pulmonary sequestration in a single institute.
Records of patients with pulmonary sequestration between January 1982 and January 2006 were reviewed retrospectively. Age, sex, symptoms, diagnostic procedures, operative findings, operative techniques, postoperative complications, and follow-up results were evaluated.
Twenty-seven patients, 17 male and 10 female, with an average age of 23.3 were operated on for pulmonary sequestration. Twenty patients had preoperative symptoms including recurrent pneumonia attacks, chest pain, hemoptysis, and shortness of breath. Chest radiography, thoracic computed tomography, aortography, magnetic resonance imaging, and bronchoscopy were used as diagnostic methods. Of the cases, 19 (70%) were intralobar pulmonary sequestration and 8 (30%) were extralobar pulmonary sequestration. Surgical procedures were lower lobectomy in 18 and segmentectomy in 1 of the patients with intralobar pulmonary sequestration and simple mass excision in all of those with extralobar pulmonary sequestration. Postoperative histopathologic examinations excluded any other alternative diagnosis. Furthermore, it detected an aspergilloma ball in 1 of the intralobar pulmonary sequestration specimens. Two patients had a postoperative complication (prolonged air leak in 1 patient and empyema in the other). During the follow-up period (mean 2.3 years), none of the patients presented a problem. No mortality was encountered.
Owing to the potentially severe complications they can cause, pulmonary sequestrations should be removed whenever they are diagnosed. Since careful dissection provides sufficient surgical comfort, preoperative identification of the aberrant vessels is not a rule for the success of the operation.
文献中罕见来自单一机构的关于肺隔离症的大型系列研究。在本研究中,我们旨在评估单一机构中肺隔离症的诊断、治疗及预后。
回顾性分析1982年1月至2006年1月间肺隔离症患者的病历。评估患者的年龄、性别、症状、诊断方法、手术所见、手术技术、术后并发症及随访结果。
27例患者接受了肺隔离症手术,其中男性17例,女性10例,平均年龄23.3岁。20例患者术前有症状,包括反复肺炎发作、胸痛、咯血及气短。胸部X线、胸部计算机断层扫描、主动脉造影、磁共振成像及支气管镜检查被用作诊断方法。其中,19例(70%)为叶内型肺隔离症,8例(30%)为叶外型肺隔离症。叶内型肺隔离症患者中18例行下叶切除术,1例行肺段切除术;叶外型肺隔离症患者均行单纯肿块切除术。术后组织病理学检查排除了任何其他可能的诊断。此外,在1例叶内型肺隔离症标本中发现曲菌球。2例患者出现术后并发症(1例为持续性漏气,另1例为脓胸)。在随访期(平均2.3年)内,所有患者均未出现问题,无死亡病例。
由于肺隔离症可能导致严重并发症,一经诊断应予以切除。由于仔细解剖可提供足够的手术操作空间,术前识别异常血管并非手术成功的必要条件。