叶内型支气管肺隔离症14例诊治分析

The Analysis of Diagnosis and Surgical Therapy of Intralobar Pulmonary Sequestration (Ils) with 14 Clinical Cases

摘要: 目的：探讨叶内型肺隔离症临床诊断和治疗的方法和价值。方法：回顾性分析2004年2月至2017年9月1例在我院诊断和接受治疗的叶内型肺隔症患者资料，其中男性8例，女性6例；年龄：19岁~66岁。术前通过增强CT及CTA确诊。均采用外科手术治疗。结果：手术病例中2例开胸手术、12例采用胸腔镜手术，胸腔镜无中转开胸，其中2例患者选择行肺楔形切除，12例行肺叶切除。术后1例患者因肺切缘渗血较多经保守治疗26天痊愈出院，另外1例术后并发乳糜胸经保守治疗30天后痊愈出院。术后随诊时间：1个月~13年，随诊结果：均无咳痰、痰中带血、肺炎，均生存良好。结论：手术治疗叶内型肺隔离症效果确切，根据术中情况，可以选择肺楔形切除或者肺叶切除。当并发大咯血时可以首先选择介入手术选择性动脉栓塞术达到暂时性止血，为后续手术争取时间和机会。

Abstract: Objective: To discuss the diagnosis and surgical treatment for intralobar pulmonary sequestration (ILS). Methods: We retrospectively gathered and analyzed the clinical data on 14 ILS patients (8 males and 6 females, aged 19 - 66 years treated in our department from February 2004 to September 2017. All cases had been diagnosed by chest enhancement CT or CTA before operation. All cases underwent surgical therapy. Results: The operations were performed successfully by thoracotomy for 2 cases, by VATS for 12 cases. Among the patients for surgical treatments wedge resection was performed for 2 patients; lobectomy was performed for 12 patients. Postoperative bleeding of one patient and chylothorax for another patient was cured after 26 days and 30 days respectively with conservative therapies. All patients were followed-up for 1 month to 13 years. 14 patients recovered well without significant complications. Conclusions: The efficacy of surgical treatment for ILS is very definite; there are some surgical modes for ILS, for instance wedge resection, lobectomy, segmentectomy. When patient occurs with massive hemoptysis, the interventional therapy should be performed firstly to acquire the opportunity for surgical treatment.