Traibi A, Seguin-Givelet A, Brian E, Grigoroiu M, Gossot D
Département thoracique, institut mutualiste Montsouris, institut du thorax Curie-Montsouris, 42, boulevard Jourdan, 75014 Paris, France.
Département thoracique, institut mutualiste Montsouris, institut du thorax Curie-Montsouris, 42, boulevard Jourdan, 75014 Paris, France; UFR SMBH, université Sorbonne Paris Cité, université Paris 13, 93000 Paris, France.
Rev Mal Respir. 2019 Feb;36(2):129-134. doi: 10.1016/j.rmr.2018.10.008. Epub 2019 Jan 24.
Until now, the traditional procedure to treat intralobar pulmonary sequestration (ILS) in adults has been a lobectomy performed by open thoracotomy. We have reviewed our data to observe if the surgical management of these lesions has evolved over the last years.
We retrospectively reviewed the records of the patients who were operated for an ILS either by posterolateral thoracotomy (PLT group), or by thoracoscopy (TS group) between 2000 and 2016.
Eighteen patients were operated for a SIL during this period. Prior to 2011, all resections were performed by thoracotomy (n=6) and after 2011 the surgical approach was either a thoracotomy (n=5) or a thoracoscopy (n=7). There was one conversion because of dense pleural adhesions and this patient was integrated in the PLT group for further analysis. ILS were more frequently encountered on the left side (n=12, 66.6 %) than on the right one (n=6, 33.3 %) and exclusively in the lower lobes. All patients of the PLT group underwent a lobectomy. In the TS group, 5 patients underwent a sublobar resection (2 segmentectomiesS, 1 basilar segmentectomy and 2 atypical resections). There was no mortality. In the PLT group, 5 patients (45 %) had complications versus one patient (14 %) in the TS group. The mean hospital stay was 7.4 days in the PLT group versus 5.4 days in the TS group.
These data confirm that ILS can be safely treated by a sublobar resection that should be performed, whenever possible, thoracoscopically.
到目前为止，治疗成人叶内型肺隔离症（ILS）的传统方法是通过开胸手术进行肺叶切除术。我们回顾了我们的数据，以观察这些病变的手术治疗在过去几年中是否有所发展。
我们回顾性分析了2000年至2016年间因ILS接受后外侧开胸手术（PLT组）或胸腔镜手术（TS组）的患者记录。
在此期间，18例患者接受了SIL手术。2011年之前，所有切除术均通过开胸手术进行（n = 6），2011年之后，手术方式为开胸手术（n = 5）或胸腔镜手术（n = 7）。有1例因致密胸膜粘连而中转开胸，该患者被纳入PLT组进行进一步分析。ILS在左侧更常见（n = 12，66.6%），而在右侧较少见（n = 6，33.3%），且仅见于下叶。PLT组所有患者均接受了肺叶切除术。在TS组中，5例患者接受了亚肺叶切除术（2例肺段切除术、1例基底段切除术和2例非典型切除术）。无死亡病例。PLT组有5例患者（45%）出现并发症，而TS组有1例患者（14%）出现并发症。PLT组的平均住院天数为7.4天，而TS组为5.4天。
这些数据证实，ILS可以通过亚肺叶切除术安全治疗，只要有可能，应采用胸腔镜手术。
