Robson Victoria K, Shieh Hester F, Wilson Jay M, Buchmiller Terry L
Department of Medicine and Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, 02115, USA.
Department of Surgery, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Fegan 3rd Floor, Boston, MA, 02115, USA.
Pediatr Surg Int. 2020 Mar;36(3):325-331. doi: 10.1007/s00383-019-04590-2. Epub 2019 Nov 9.
This retrospective cohort study compares the natural history of patients with extralobar sequestrations (ELS) who do not undergo intervention with those who undergo resection to assess the safety of non-operative management.
126 patients with pulmonary sequestrations or congenital pulmonary airway malformations born between 1999 and 2016 were identified. 49 patients had ELS on postnatal imaging, but two were excluded for associated congenital diaphragmatic hernia. Demographic and clinical data were retrospectively reviewed, with phone follow-up for non-operative patients with no records for > 1 year. Statistical analysis was by Fisher's exact test or Wilcoxon signed-rank test (two-tailed p < 0.05).
40% (19/47) were managed non-operatively and 60% (28/47) underwent resection. Non-operative patients were less likely to have an intrathoracic ELS: 47% (9/19) vs. 75% (21/28), p = 0.07. No symptoms were attributable directly to the ELS. Non-operative patients had median follow-up 3.2 years, during which time 88% (15/17) of ELS decreased in size on serial imaging. For patients who underwent resection, there was 100% concordance between imaging and intraoperative findings. There was no evidence of inflammation, infection or malignancy on final pathology, though 57% (16/28) of resected lesions had foci of non-aerated cysts.
Although further longitudinal study is required, this study supports the safety of non-operative ELS management.
本回顾性队列研究比较了未接受干预的肺叶外型肺隔离症（ELS）患者与接受切除术患者的自然病史，以评估非手术治疗的安全性。
确定了1999年至2016年间出生的126例患有肺隔离症或先天性肺气道畸形的患者。49例患者在产后影像学检查中发现有ELS，但其中2例因合并先天性膈疝被排除。回顾性分析人口统计学和临床数据，对无记录超过1年的非手术患者进行电话随访。采用Fisher精确检验或Wilcoxon符号秩检验进行统计学分析（双侧p<0.05）。
40%（19/47）的患者接受了非手术治疗，60%（28/47）的患者接受了切除术。非手术治疗的患者胸腔内ELS的可能性较小：47%（9/19）对75%（21/28），p=0.07。没有症状可直接归因于ELS。非手术治疗的患者中位随访时间为3.2年，在此期间，88%（15/17）的ELS在系列影像学检查中体积减小。对于接受切除术的患者，影像学检查结果与术中发现完全一致。最终病理检查未发现炎症、感染或恶性肿瘤的证据，尽管57%（16/28）的切除病变有未充气囊肿灶。
尽管需要进一步的纵向研究，但本研究支持非手术治疗ELS的安全性。
