Halkic N, Cuénoud P F, Corthésy M E, Ksontini R, Boumghar M
Department of Surgery, CHUV, Lausanne, Switzerland.
Eur J Cardiothorac Surg. 1998 Aug;14(2):127-33. doi: 10.1016/s1010-7940(98)00154-7.
Pulmonary sequestration is a continuum of lung anomalies for which no single embryonic hypothesis is yet available. The aim of this study was to assess the diagnostic tools and treatment for the rare condition, pulmonary sequestration, in an unspecialised centre.
We performed an analysis of 26 cases of pulmonary sequestration (paediatric and adult) operated at the Centre Hospitalier Universitaire Vaudois between May 1959 and May 1997. A review of the extralobar and intralobar types of sequestrations is discussed. Angiography is compared to other diagnostic tools in this condition, and treatment is discussed.
Twenty-six cases of pulmonary sequestrations, a rare congenital pulmonary malformation, were operated on in the defined time period. Seventy-three percent (19) of the cases were intralobar and 27% (seven) extralobar. Extralobar localisation was basal in 71% and situated between the upper and the lower lobe in 29%. In six cases, the diagnosis was made by exploratory thoracotomy. In the other 20 cases, diagnosis was evoked on chest X-ray and confirmed by angiography. Lobectomy (46%) was the most common treatment procedure. Segmental resection was performed in 30% of the cases and bilobectomy in 4%. Post-operative morbidity was low. The most significant complications were pleural empyema, haemothorax and haemopneumoperitoneum in case of extralobar sequestration. There was no evidence of metaplasia or pre-neoplastic changes.
Despite its rarity, some radiological features are sufficiently suggestive of diagnosis of pulmonary sequestration. Investigations are necessary in order to avoid unexpected pathology at the time of operation. Resection of the involved lung leads to excellent results and the long-term outcome is highly favourable.
肺隔离症是一系列肺异常疾病，目前尚无单一的胚胎学假说能够完全解释其成因。本研究旨在评估在非专科中心针对这种罕见疾病——肺隔离症的诊断工具和治疗方法。
我们对1959年5月至1997年5月间在沃州大学中心医院接受手术的26例肺隔离症患者（包括儿童和成人）进行了分析。文中讨论了肺叶外型和肺叶内型隔离症的相关情况。将血管造影与该病症的其他诊断工具进行了比较，并探讨了治疗方法。
在规定时间段内，共对26例肺隔离症（一种罕见的先天性肺畸形）患者进行了手术。其中73%（19例）为肺叶内型，27%（7例）为肺叶外型。肺叶外型隔离症位于肺底部的占71%，位于上下叶之间的占29%。6例患者通过开胸探查术确诊。其余20例患者通过胸部X线检查发现问题并经血管造影确诊。肺叶切除术（46%）是最常见的治疗方法。30%的患者接受了肺段切除术，4%的患者接受了双叶切除术。术后发病率较低。最严重的并发症是肺叶外型隔离症患者出现的胸膜脓胸、血胸和气腹。未发现化生或癌前病变的迹象。
尽管肺隔离症较为罕见，但一些放射学特征足以提示其诊断。为避免手术时出现意外病理情况，进行相关检查是必要的。切除受累肺叶可取得良好效果，长期预后非常乐观。
