肺隔离症4例诊治体会及文献复习

doi:10.3969/j.issn.1009-976X.2020.03.026

摘要/Abstract

摘要： 目的探讨肺隔离症的诊断和治疗策略。方法 2017年7月至2019年6月收治的4例肺隔离症患者,3例患者行胸腔镜手术治疗,1例行介入下血管塞封堵迷走供血动脉,对其诊治过程和临床资料进行回顾性分析,总结诊治过程中的体会。结果 4例肺隔离症患者均接受治疗,1例患者接受介入下血管塞封堵迷走供血动脉后恢复顺利;1例患者胸腔镜下肺叶切除术后恢复顺利;2例患者接受胸腔镜下隔离肺叶切除术,其中1例恢复顺利,1例因胸腔进行性出血行胸腔镜下开胸止血术,后恢复顺利。术后3月复查胸部螺旋计算机体层摄影血管造影显示,3例行胸腔镜下隔离肺叶或肺叶切除手术患者的异常肺叶及供血动脉消失,行介入下血管塞封堵异常血管的1例患者的迷走供血动脉被栓塞,栓塞血管远端已无血流供应,隔离肺组织充血表现较前明显好转,4例患者随访7~31个月,未见复发。在手术时间、术中出血量、术后疼痛、术后胸腔闭式引流量、术后并发症、住院时间及住院费用等方面,介入栓塞治疗均优于胸腔镜手术治疗。结论胸腔镜手术是目前处理肺隔离症的主要方式,介入栓塞治疗肺隔离症同样是一种安全、有效、微创的治疗方法,尤其对以咯血为主要症状,凝血功能异常且病情较重者效果佳。

关键词: 血管塞, 胸腔镜手术, 螺旋计算机体层摄影血管造影, 开胸手术, 介入栓塞, 肺隔离症

Abstract: Objective To explore the diagnosis and treatment strategies of pulmonary sequestration. Methods Four patients with pulmonary sequestration were admitted from July 2017 to June 2019 in our hospital. Three patients underwent video-assisted thoracic surgery, and one patient underwent interventional surgery by vascular plug. The diagnosis and treatment process and clinical data were retrospectively analyzed, and the experience was summarized. Results All four patients were treated. One patient received interventional surgery by vascular plug and recovered smoothly. One patient received video-assisted thoracic lobectomy and recovered smoothly. Two patients received video-assisted thoracic sequestration lobectomy, and one patient recovered well. Unfortunately, one patient suffered video-assisted thoracic surgery once more time for active thoracic bleeding, and the patient finally recovered. A review of chest spiral computed tomography angiography at 3 months after surgery revealed that these abnormal lung lobes and blood supply arteries disappeared in three patients who underwent video-assisted thoracic sequestration lobectomy or lobectomy, and the abnormal blood vessels was completely blocked by vascular plug after interventional surgery in one patient. There was no blood supply to the distal end of the embolized blood vessel, and the congestion of the lung tissue of pulmonary sequestration was significantly better than before. Four patients were followed up for 7-31 months without recurrence. In terms of operation time, intraoperative blood loss, postoperative pain, volume of closed chest drainage, postoperative complications, length of stay, and hospitalization costs, interventional embolization were all superior to video-assisted thoracic surgery in pulmonary sequestration. Conclusion Video-assisted thoracic surgery is the main treatment for pulmonary sequestration at present. Interventional embolization is also a safe, effective, and minimally invasive treatment for pulmonary sequestration, especially for those who have hemoptysis as the main symptom, abnormal blood coagulation function, and severe illness.

Key words: spiral computed tomography angiography （SCTA）, video-assisted thoracic surgery, thoracotomy, vascular plug, pulmonary sequestration, interventional embolization

中图分类号:

R655.3

郭权威, 颜峻, 钟承华, 况军, 莫益俊, 谭剑峰, 李东方, 张建华. 肺隔离症4例诊治体会及文献复习[J]. 岭南现代临床外科, 2020, 20(03): 381-385.

GUO Quan-wei, YAN Jun, ZHONG Cheng-hua, KUANG Jun, MO Yi-jun, TAN Jian-feng, LI Dong-fang, ZHANG Jian-hua. The experience of diagnosis and treatment process of four patients with pulmonary sequestration and literature review[J]. Lingnan Modern Clinics in Surgery, 2020, 20(03): 381-385.

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