Bermúdez C, Pérez-Wulff J, Bufalino G, Sosa C, Gómez L, Quintero R A
Unidad de Perinatología, Hospital Universitario de Caracas, Universidad Central de Venezuela, Caracas, Venezuela.
Ultrasound Obstet Gynecol. 2007 May;29(5):586-9. doi: 10.1002/uog.3944.
Bronchopulmonary sequestration (BPS), which can be intralobar or extralobar, is a rare developmental anomaly of the lung characterized by nonfunctional pulmonary tissue without communication with the tracheobronchial tree and with an aberrant systemic arterial blood supply. The intralobar type is typically within the pleural cavity with an arterial feeding vessel generally arising from the thoracic aorta and with venous drainage into the left atrium. The prognosis is poor in cases diagnosed before 26 weeks' gestation and when there is mediastinal shift, polyhydramnios and fetal hydrops. The ideal prenatal management option remains undefined. We present a series of three complicated cases of intralobar BPS treated prenatally with percutaneous ultrasound-guided fetal sclerotherapy (FST). The feeding vessel was successfully accessed percutaneously under ultrasound guidance in all cases. FST with polidocanol resulted in complete obliteration of the blood flow to the mass. Abnormal Doppler findings, ascites, hydrops and polyhydramnios resolved and all patients were delivered at term. Antenatal treatment of patients with complicated BPS can be successfully achieved with FST, which is a simple and inexpensive technique. Comparison of risks and benefits of this approach with other techniques is warranted.
肺隔离症（BPS）可分为叶内型或叶外型，是一种罕见的肺发育异常，其特征为无功能的肺组织，不与气管支气管树相通，且有异常的体循环动脉血供。叶内型通常位于胸腔内，供血动脉一般发自胸主动脉，静脉血流入左心房。妊娠26周前诊断出的病例，以及出现纵隔移位、羊水过多和胎儿水肿时，预后较差。理想的产前管理方案仍不明确。我们报告了一系列三例叶内型BPS的复杂病例，这些病例在产前接受了经皮超声引导下的胎儿硬化治疗（FST）。在所有病例中，均在超声引导下经皮成功进入供血血管。用聚多卡醇进行FST导致肿块的血流完全闭塞。异常的多普勒表现、腹水、水肿和羊水过多均得到缓解，所有患者均足月分娩。对于复杂BPS患者，产前治疗可通过FST成功实现，这是一种简单且廉价的技术。有必要将这种方法与其他技术的风险和益处进行比较。
