Ichino Martina, Macchini Francesco, Morandi Anna, Persico Nicola, Fabietti Isabella, Zanini Andrea, Leva Ernesto
Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milano, Lombardia, Italy.
Department of Obstetrics and Gynecology "L. Mangiagalli", Fetal Medicine and Surgery Service, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milano, Lombardia, Italy.
European J Pediatr Surg Rep. 2020 Jan;8(1):e62-e67. doi: 10.1055/s-0040-1713901. Epub 2020 Sep 18.
Pulmonary sequestration (PS) is mostly asymptomatic but there is a proportion of fetuses that develop hydrops, leading to fetal or neonatal death. Fetal treatments are available, but postnatal management of the residual lesions is not uniformly defined. We present two cases of combined pre- and postnatal minimally invasive approach to complicated extra-lobar PS. Patient 1 presented with complicated PS at 31 weeks of gestation. Ultrasound-guided laser coagulation of the anomalous artery was successful. The patient was born asymptomatic at 38 weeks. Neonatal magnetic resonance imaging (MRI) showed a residual mass, confirmed by computed tomography (CT) at 6 months. No systemic artery was described, but perfusion was present. We decided for thoracoscopic resection. A residual artery was identified and sealed. Patient 2 presented with complicated PS at 25 weeks of gestation, underwent laser coagulation of the anomalous artery and was born asymptomatic at 38 weeks. Neonatal MRI showed persistence of the lesion, confirmed by CT scan at 4 months. We proceeded with thoracoscopic resection. A residual vessel was ligated. The patients 1 and 2 are now 24 and 21 months old, respectively, and healthy. Prenatal treatment of complicated PS is a life-saving procedure. Postnatal thoracoscopic resection of the residual lesion is feasible and safe; we believe it is the best course of treatment to grant the complete excision of the malformation.
肺隔离症（PS）大多无症状，但有一部分胎儿会出现水肿，导致胎儿或新生儿死亡。虽然有胎儿治疗方法，但残留病变的产后管理尚无统一标准。我们报告两例采用产前和产后微创相结合的方法治疗复杂型叶外型肺隔离症的病例。病例1在妊娠31周时被诊断为复杂型肺隔离症。超声引导下对异常动脉进行激光凝固术成功。患者在38周时无症状出生。新生儿磁共振成像（MRI）显示有残留肿块，6个月时经计算机断层扫描（CT）证实。未发现体动脉，但有灌注。我们决定进行胸腔镜切除术。术中发现并封闭了一条残留动脉。病例2在妊娠25周时被诊断为复杂型肺隔离症，接受了异常动脉激光凝固术，38周时无症状出生。新生儿MRI显示病变持续存在，4个月时经CT扫描证实。我们进行了胸腔镜切除术。结扎了一条残留血管。病例1和病例2现在分别为24个月和21个月大，身体健康。复杂型肺隔离症的产前治疗是一种挽救生命的措施。产后胸腔镜切除残留病变可行且安全；我们认为这是实现畸形完全切除的最佳治疗方案。
