肺隔离症16例临床分析

摘要

Objective To explore the clinical characteristics of pulmonary sequestration (PS) patients in or-der to improve the understanding and clinical diagnosis and treatment level of PS. Methods The clinical data of 16 PS patients were collected and retrospectively analyzed. Results Among the 16 PS patients, 14 cases (87. 5% ) showed symptoms of recurrent pulmonary infection, and imaging examination showed that the onset of PS was in the double low lungs, especially in the left low lung (87. 5% ), which performed a lump or cystic. Chest spiral CT en-hanced scanning and three-dimensional reconstruction of vascular imaging could show the abnormal feeding artery which were originated from the body circulation. 12 cases were examined by brochoscopic examination, which showed normal in 7 cases (58. 4% ), and 4 cases (33. 3% ) with purulent secretions in bronchial way. 14 cases (87. 5% ) were the intralobar type. The misdiagnosis rate with chest plain CT scanning was 87. 5% , and the misdiagnosis rate with chest plain and enhanced CT scanning was 70. 0% . Among the 16 PS patients, 12 cases were found that the ab-normal feeding artery were originated from thoracic aorta, and 13 cases had one abnormal feeding artery. Because of the improper operation, major bleeding in operation occurred in 3 cases. After operation, 13 cases of follow-up pa-tients had no recurrence. Conclusion The incidence of PS is low, which is easy to be misdiagnosed and missed di-agnosed. It can be diagnosed by spiral CT enhanced scanning and three-dimensional reconstruction of vascular ima-ging. Surgical treatment is the best treatment for PS, and the proper handling of abnormal supply arteries is the key point.%目的：探讨肺隔离症(pulmonary sequestration,PS)患者的临床特点,以提高对 PS 的认识和临床诊治水平。方法收集我院16例 PS 患者的临床资料进行回顾性分析。结果16例 PS 患者中14例(87.5%)表现为反复发作的肺部感染症状,影像学检查 PS 均位于双下肺,尤以左下肺多见(87．5%),形态呈肿块状或囊性表现,胸部螺旋 CT 增强及三维重建血管成像可以显示起源于体循环的异常供血动脉,12例患者行支气管镜检查,镜下正常者7例(58．4%),4例(33．3%) 支气管内见脓性分泌物,16例 PS 患者中14例(87．5%)为叶内型,胸部普通 CT 平扫误诊率为87．5%,胸部普通 CT 平扫+增强扫描误诊率为70.0%,16例PS 患者中异常供血动脉源于胸主动脉者12例,异常供血动脉1支者13例,3例患者因术中操作不当发生大出血,术后随诊的13例患者均无复发。结论 PS 发病率低,容易误诊及漏诊,螺旋 CT 增强及三维重建血管成像可以确诊 PS,外科手术是本病的最佳治疗方法,术中重点是异常供血动脉的处理。