Accarain Anna Ayako, Laureys Marc, Joyeux Luc, Damry Nasroola, Steyaert Henri, Reusens Helena
Department of Surgery, Université Libre de Bruxelles, Brussels, Belgium.
Department of Radiology, Brugmann University Hospital, Brussels, Belgium.
European J Pediatr Surg Rep. 2022 Oct 10;10(1):e141-e144. doi: 10.1055/s-0042-1757570. eCollection 2022 Jan.
Bronchopulmonary sequestration is a rare congenital lung dysplasia. An intralobar sequestration (ILS) is a nonfunctional mass within the lung parenchyma without bronchial communication and with aberrant systemic arterial blood supply. Surgical resection or close observation can be proposed in the management of asymptomatic and low-risk ILS, but there is a lack of consensus. Endovascular embolization before thoracoscopic resection of ILS has been described to limit perioperative bleeding. Another technique previously reported is the injection of methylene blue in the feeding artery to macroscopically mark the sequestration from the healthy lung. In that way, a nonanatomical resection can be performed instead of a lobectomy without the risk of leaving abnormal lung tissue in place. We describe the first two cases of these two techniques combined: a 3-year-old girl with an ILS in the right lower lobe with an artery originating from the abdominal aorta, and a 14-month-old girl with an ILS in the right lower lobe with an artery coming from the celiac trunk. The combination of embolization and injection of methylene blue in the aberrant artery leads to a clear macroscopic demarcation of the blue-colored ILS from the healthy lung parenchyma and allowed safe nonanatomical resection of the ILS without risk of bleeding or compromising normal lung tissue.
支气管肺隔离症是一种罕见的先天性肺发育异常。叶内型隔离症（ILS）是肺实质内的一个无功能肿块，无支气管相通，有异常的体循环动脉血供。对于无症状且低风险的ILS，可考虑手术切除或密切观察，但目前尚无共识。据描述，在胸腔镜切除ILS前进行血管内栓塞可减少围手术期出血。先前报道的另一种技术是向供血动脉注射亚甲蓝，以便在宏观上区分隔离肺与健康肺组织。通过这种方式，可以进行非解剖性切除，而不是肺叶切除术，从而避免残留异常肺组织的风险。我们描述了首例将这两种技术联合应用的病例：一名3岁女童，右肺下叶患有ILS，其供血动脉起源于腹主动脉；另一名14个月大的女童，右肺下叶患有ILS，其供血动脉来自腹腔干。在异常动脉内进行栓塞并注射亚甲蓝，可使蓝色的ILS与健康肺实质在宏观上清晰分界，从而安全地进行ILS的非解剖性切除，且无出血风险或对正常肺组织造成损害。
