肺隔离症的诊断及外科治疗初向阳,张连斌,薛志强,张竞(中国人民解放军总医院胸外科,北京100853)摘要:目的总结肺隔离症(pulmonarysequesmnion,PS)的临床特点、诊断及外科治疗经验。方法回顾性分析1990-2007年我院胸外科经手术治疗69例PS的临床病理资料。结果本纽.PS的术前诊断率为65.2%(45/69);术前行胸片和肺CT平扫41例,诊断率为53.7%(22/41);术前行增强CT薄层扫描28例,诊断率为82.1%(23/28)。61例叶内型PS行肺叶切除术,8例叶外型行隔离肺局部切除术。术中发现异常供血动脉55例,來源于胸主动脉,8例來源于腹腔干,5例來源于膈肌动脉,1例來源于肋间动脉。全部患者手术顺利,无围手术期死亡。结论PS的谋诊率较高,胸部増强CT薄层扫描冇利于PS的诊断。手术是治疗PS安全、冇效的方法。关键词:肺隔离症;诊断;手术中图法分类号:文献标识码:AThediagnosisandsurgicaltreatmentofpulmonarysequestrationCHUXiang-yang,ZHANGLian-bin,XUEZhi-qiang,ZHANGJing(DepartmentofthoracicSurgery,thePLAGeneralHospital,Beijing100853,China)Abstract:ObjectiveTosummarizetheexperiencesofthediagnosisandsurgicaltreatmentofpulmonarysequestration.MethodsTheclinicaldataof69patientswithpulmonarysequestrationunderwentoperationfrom1990to2007inPLAgeneralhospitalwererctrospccitvclyreviewed・ResultsOf69patients,45werediagnosedpulmonarysequestrationbeforeoperation,andthediagnosisrateswas65・2%(45/69).Pre-operationchestX-rayandplainCT-scanwereperformedin41cases,22cases(53.7%)werecorrectlydiagnosed・ContrastenhancedspiralCTscanwereperformedin28patients,23(85.5%)werecorrectlydiagnosed・Sixty-onepatientswithintralobarsequestratrationunderwentlobectomy,and8patientswithextralobarsequestrationunderwentlocallesionresection.Theabnormalsupplyarteryswereoriginatedfromthoracicmainarteryin55cases,celiaccirteryin8cases,diaphragmarteryin5cases,interlobearteryin1case・Allpatientsrecoveredsmoothly.NooperativedeathoccuiTed.ConclUsi0nPulmonarysequestrationisararedisease,andpartofpatientsareaftenmis-diagnosed.ContrastenhancedspiralCTscanmayimprovethediagnosisofpulmonarysequestration.Operationisasafeandeffectivemethodtotreatpulmonarysequestration.Keywords:pulmonarysequestration;diagnosis;operation作者简介:初向阳,男,山东省莱芜市人,硕匕副教授,发表论文io余篇,主要从事肺癌■儉管癌■胸部创伤的基础与临床方面的研究。电话:(010)66939632,E-mail:xuezhiq2001ahoo.com.cn收稿日期:20081021:修回日期:200812-11肺隔离症(pulmonarysequestration,PS)是一种较少见的先天性肺发育异常,其特征是部分胚胎肺纽•织与正常支气管不交通,并与正常肺组织隔开,其血液供应來自体循环的异常分支,临床上常被误诊为支气管扩张、肺囊肿和肺癌⑴。1990-2007年我科经手术治疗PS69例,现总结报告如下。1资料与方法1.1临床资料患者共69例,男性41例,女性28例,年龄16〜64(39.2±8.7)岁。既往有反复发热、咳嗽、咳痰61例,其中伴间断咳血12例,人咳血2例,无症状查体发现8例。病变位于左肺下叶53例(76.8%),右肺下叶15例(21.7%),左肺上叶1例(1.5%)。术前诊断为PS45例(65.2%),误诊为支气管扩张16例(23.2%),肺囊肿5例(7.2%),肺癌3例(4.3%)。术前胸片和肺CT平扫检查PS的诊断率为53.7%(22/41),增强CT薄层扫描检查的诊断率82」%(23/28)o1.2诊断方法患者术前均行影像学检查。术前胸部X线平片检查69例,呈圆形、椭圆行或不规则形肿块42例,密度大多均匀,边界清楚;囊性改变27例,其中7例为大片高密度渗出灶,灶中冇多发空泡状影。帅CT平扫41例,病变表现为密度均匀的实质性肿块19例,密度不均匀的肿块13例,囊性改变7例,支气管扩张2例;其中22例肺CT平扫发现病变与胸主动脉或脊柱冇鼠尾状蒂和连,呈尖部指向脊柱旁的蝌蚪状。术前行増强CT薄层扫描检查28例,23例发现鼠尾状血管影。术前主动脉造影检查6例,均发现异常供血血管...