Pedroni Giada, Albo Giulia, Galbiati Francesca, Borzani Irene Maria, Zanini Andrea, Leva Ernesto, Macchini Francesco, Mazzoleni Stefano
Pediatric Surgery, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy.
Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
J Clin Med. 2025 Apr 27;14(9):3018. doi: 10.3390/jcm14093018.
: Bronchopulmonary sequestration (BPS) is a portion of dysplastic pulmonary tissue not communicating with the tracheobronchial tree. Its vascularization is provided by abnormal arteries originating from the systemic circulation. Previous papers report different venous drainage (VD) between intralobar (ILS) and extralobar sequestration (ELS), respectively, into the pulmonary or the systemic veins. The aim of our study is to investigate the VD as independent predictor of the type of PS. : We retrospectively reviewed 41 pediatric patients who underwent surgery for BPS between 2016 and 2023 in two centers. Patients treated prenatally and without pre-operative CT were excluded. BPS were classified either intra or extra lobar. Pre-operative radiological BPS classification prediction was assessed based on intra-operative thoracoscopic findings. Lesion VD and sharp margins (SM) on pre-operative CT were assessed as predicting factors. : A total of 36 patients were included: 24 ILS and 12 ELS. All patients underwent thoracoscopic resection without major complications. VD is significantly different between ILS and ELS: 96% of ILS drain into the pulmonary system while 83% of ELS drain into a systemic vein ( < 0.00001). On pre-operative CT, the absence of SM predicts for an ILS in 100% of cases. SM has a PPV for ELS of 85.7%. The combination of SM and systemic VD has a PPV for ELS of 91.7%. : In our series, the absence of SM alone is suggestive for an ILS in 100% of cases, while the combination of SM and systemic VD is more accurate in predicting ELS. This may help improving surgical planning and family consultation.
支气管肺隔离症（BPS）是一部分发育异常的肺组织，与气管支气管树不相通。其血供由起源于体循环的异常动脉提供。既往文献分别报道了叶内型（ILS）和叶外型隔离症（ELS）不同的静脉引流（VD）情况，分别引流至肺静脉或体静脉。我们研究的目的是调查静脉引流作为肺隔离症类型的独立预测因素。
我们回顾性分析了2016年至2023年期间在两个中心接受BPS手术的41例儿科患者。排除产前治疗且未进行术前CT检查的患者。BPS分为叶内型或叶外型。根据术中胸腔镜检查结果评估术前放射学BPS分类预测。术前CT上的病变静脉引流和清晰边缘（SM）被评估为预测因素。
共纳入36例患者：24例叶内型和12例叶外型。所有患者均接受胸腔镜切除术，无严重并发症。叶内型和叶外型的静脉引流有显著差异：96%的叶内型引流至肺循环，而83%的叶外型引流至体静脉（<0.00001）。在术前CT上，无清晰边缘在100%的病例中预测为叶内型。清晰边缘对叶外型的阳性预测值为85.7%。清晰边缘和体静脉引流的联合对叶外型的阳性预测值为91.7%。
在我们的系列研究中，单独无清晰边缘在100%的病例中提示为叶内型，而清晰边缘和体静脉引流的联合在预测叶外型方面更准确。这可能有助于改进手术规划和家属咨询。
