肺隔离症的分布、诊断和治疗：208 例报告。
Distribution, diagnosis, and treatment of pulmonary sequestration: Report of 208 cases.
机构信息
Department of Thoracic Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, China.
Department of Thoracic Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, China.
出版信息
J Pediatr Surg. 2019 Jul;54(7):1286-1292. doi: 10.1016/j.jpedsurg.2018.08.054. Epub 2018 Sep 7.
OBJECTIVE
This study was performed to explore the clinical features, typing, distribution, and treatment of pulmonary sequestration (PS), with the aim of improving the awareness and treatment of this condition.
METHODS
Clinical data regarding surgical procedures, outcomes, and prognosis of 208 pediatric patients with PS who were treated in our center from January 2005 to October 2017 were retrospectively analyzed.
RESULTS
PS was confirmed by ultrasonography, enhanced computed tomography (CT), and/or magnetic resonance imaging (MRI) before surgery, and the surgeries were smoothly performed in all 208 patients (138 males, 70 females; age, 1 month to 14 years; mean age, 19.70 ± 48.82 months). The operative time ranged from 10 to 230 min (mean, 70 ± 48.75 min), and the intraoperative blood loss volume ranged from 1 to 200 ml (mean, 5 ± 18 ml). PS was located in multiple sites of the thoracic cavity and was also found in some rare locations such as the neck and abdomen. The feeding arteries of the PS mainly arose from the thoracic aorta or abdominal aorta, and a few of them originated from other vessels in the systemic circulation. The venous drainage differed between intralobar and extralobar PS: in patients with intralobar PS, the venous drainage was mainly via the pulmonary veins, especially the lower pulmonary veins; in patients with extralobar PS, the venous drainage was via the azygos vein and hemiazygos vein or reached the right atrium via the vena cava. The infection rate in children with intralobar sequestration was 71.17% (79/111), and that in children with extralobar sequestration was 31.37% (16/51).
CONCLUSION
PS has increasingly been detected by prenatal ultrasonography, and enhanced CT and MRI are the main techniques for diagnosing PS. Once confirmed, PS should be surgically resected. We choose an age of 6 to 12 months for surgical resection. Minimally invasive video-assisted thoracic surgery has many advantages in the treatment of PS and can be the treatment of choice for this condition.
TYPE OF STUDY
Treatment Study.
LEVEL OF EVIDENCE
Level III.
目的
本研究旨在探讨肺隔离症（PS）的临床特征、分型、分布和治疗方法，以提高对该病的认识和治疗水平。
方法
回顾性分析 2005 年 1 月至 2017 年 10 月期间在我院接受治疗的 208 例儿科 PS 患者的手术程序、结果和预后的临床资料。
结果
术前均通过超声、增强 CT（CT）和/或磁共振成像（MRI）确诊 PS，208 例患者均顺利完成手术（男 138 例，女 70 例；年龄 1 个月至 14 岁；平均年龄 19.70±48.82 个月）。手术时间为 10230 min（平均 70±48.75 min），术中出血量为 1200 ml（平均 5±18 ml）。PS 位于胸腔多个部位，也存在于颈部和腹部等一些罕见部位。PS 的供血动脉主要来自胸主动脉或腹主动脉，少数来自体循环中的其他血管。叶内型 PS 的静脉引流主要通过肺静脉，尤其是下肺静脉；叶外型 PS 的静脉引流通过奇静脉和半奇静脉，或通过腔静脉到达右心房。叶内型隔离症患儿的感染率为 71.17%（79/111），叶外型隔离症患儿的感染率为 31.37%（16/51）。
结论
产前超声检查越来越多地发现 PS，增强 CT 和 MRI 是诊断 PS 的主要技术。一旦确诊，PS 应行手术切除。我们选择 6~12 月龄行手术切除。微创电视辅助胸腔镜手术在 PS 治疗中有许多优势，是治疗该病的首选方法。
研究类型
治疗研究。
证据水平
III 级。
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