Becmeur F, Horta-Geraud P, Donato L, Sauvage P
Chirurgien Pédiatre, Service de Chirurgie Infantile Hôpital Hautepierre, Strasbourg, France.
J Pediatr Surg. 1998 Mar;33(3):492-6. doi: 10.1016/s0022-3468(98)90095-1.
BACKGROUND/PURPOSE: With the development of antenatal diagnosis of pulmonary sequestrations, the authors decided to define more accurate perinatal operative indications.
METHODS/RESULTS: Antenatal ultrasound scanning (US) enabled the diagnosis of congenital pulmonary malformation in 10 cases between the twentieth and the thirty-third week of amenorrhea (WA; average, 26 WA). An absolute or relative regression of the thoracic mass size was observed in five patients. The systemic arterial blood supply was identified in four patients by Doppler US. Two fetuses required treatment. One of them suffered from a voluminous sequestration, larger than one hemithorax, with polyhydramnios. Three successive paracentesis of ascites and amniotic fluid allowed the pregnancy to continue until term. The second fetus had a sudden left hydrothorax at 30 WA and was treated by a pleuroamniotic shunt. Five spontaneous partial involutions of the mass during the antenatal period were observed. The 10 patients underwent surgery after birth. There was no mortality. Morbidity occurred in one case of antenatal treatment. Twenty-eight other cases of antenatal diagnosis of pulmonary sequestration have been described in the medical literature. Spontaneous involution of the mass has been reported in eight fetuses and its complete disappearance in two cases. Thirteen fetuses had polyhydramnios. Five of these progressed spontaneously without treatment; only two survived. Two other fetuses were drained or punctured, and one survived. Premature deliveries were undertaken for the six other fetus; there was one perinatal death.
Sequestrations with polyhydramnios may be treated in an early prenatal period. Mortality and morbidity rates are still high. At birth, large-sized sequestrations (more than half a hemithorax) must be operated on, even in cases of no respiratory distress. Medium-sized sequestrations must be operated on to remove the mass. Small and asymptomatic sequestrations must be operated on in case of intralobar forms (often cystic), or with a big blood supply. The artery may be responsible for severe complications (hemoptysis, aneurysm).
背景/目的：随着肺隔离症产前诊断技术的发展，作者决定明确更准确的围产期手术指征。
方法/结果：产前超声扫描（US）在闭经第20至33周（平均26周）期间诊断出10例先天性肺畸形。5例患者观察到胸腔肿块大小出现绝对或相对缩小。4例患者通过多普勒超声确定了体循环动脉供血。2例胎儿需要治疗。其中1例患有巨大隔离症，大于半侧胸腔，并伴有羊水过多。连续3次穿刺抽取腹水和羊水使妊娠得以持续至足月。第2例胎儿在孕30周时突然出现左侧胸腔积液，并接受了胸腔羊膜分流术治疗。产前观察到5例肿块自发部分消退。10例患者出生后接受了手术。无死亡病例。1例产前治疗出现并发症。医学文献中还描述了其他28例肺隔离症的产前诊断病例。8例胎儿报告有肿块自发消退，2例肿块完全消失。13例胎儿有羊水过多。其中5例未经治疗自发好转；仅2例存活。另外2例胎儿进行了引流或穿刺，1例存活。其他6例胎儿进行了早产；有1例围产期死亡。
伴有羊水过多的隔离症可在产前早期进行治疗。死亡率和发病率仍然很高。出生时，即使无呼吸窘迫，大型隔离症（超过半侧胸腔）也必须进行手术。中型隔离症必须手术切除肿块。小型无症状隔离症，若为叶内型（通常为囊性）或血供丰富，则必须进行手术。该动脉可能导致严重并发症（咯血、动脉瘤）。
