全胸腔镜下手术治疗小儿肺隔离症的疗效与安全性分析

目的探讨全胸腔镜下手术治疗小儿肺隔离症的临床疗效与安全性。方法回顾性分析本院2014年2月至2017年8月实施的33例全胸腔镜下肺隔离症手术患儿临床资料,其中男22例,女11例;年龄2个月至12岁1个月。患儿均经术前胸部CT增强明确诊断,手术采取三孔法,根据病变情况选择肺叶切除或不规则切除。结果 33例患儿均在全胸腔镜下顺利完成手术,无一例中转开胸手术,19例行肺叶切除术,6例行不规则肺切除术,1例行肺段切除术,7例行叶外型肺隔离症切除术。结论全胸腔镜手术治疗小儿肺隔离症安全、有效,提高手术技巧可减少术中出血,提高手术的安全性。     

肺隔离症12例诊断和治疗分析

目的总结12例小儿肺隔离症的诊断和治疗经验。 方法1994-01—2006-08,对温州医学院附属育英儿童医院收治的12例经手术和病理检查证实为肺隔离症的患儿临床资料进行回顾性分析。 结果12例肺隔离症患儿胸部X线均发现肺部异常阴影,7例呈圆形、类圆形或不规则实性块影,5例呈囊性及多囊性阴影改变;术前确诊5例,1例 经主动脉逆行造影证实,4例经螺旋CT三维重建、MRI检查发现胸主动脉与病灶之间有异常血管相通,术前高度怀疑肺隔离症3例,术前有4例误诊 ;8例叶内型肺隔离症患儿行肺叶切除术,4例叶外型肺隔离症行单纯隔离肺切除术。 结论临床医师应提高对肺隔离症的认知和重视程度。为降低肺隔离症误诊率,对可疑的肺隔离症患儿提倡螺旋CT三维重建和胸部MRI检查。     

�θ���֢12����Ϻ����Ʒ���

目的总结12例小儿肺隔离症的诊断和治疗经验。方法1994-01—2006-08,对温州医学院附属育英儿童医院收治的12例经手术和病理检查证实为肺隔离症的患儿临床资料进行回顾性分析。结果12例肺隔离症患儿胸部X线均发现肺部异常阴影,7例呈圆形、类圆形或不规则实性块影,5例呈囊性及多囊性阴影改变;术前确诊5例,1例经主动脉逆行造影证实,4例经螺旋CT三维重建、MRI检查发现胸主动脉与病灶之间有异常血管相通,术前高度怀疑肺隔离症3例,术前有4例误诊;8例叶内型肺隔离症患儿行肺叶切除术,4例叶外型肺隔离症行单纯隔离肺切除术。结论临床医师应提高对肺隔离症的认知和重视程度。为降低肺隔离症误诊率,对可疑的肺隔离症患儿提倡螺旋CT三维重建和胸部MRI检查。     

先天性肺隔离症的诊断和外科治疗

目的总结小儿先天性肺隔离症的诊断和外科治疗经验。方法对8例经手术、病理证实先天性肺隔离症患儿的临床资料进行回顾性分析。结果8例先天性肺隔离症患儿术前有3例误诊；6例叶内型行肺叶切除术，2例叶外型行单纯隔离肺切除术。术后未发生并发症。结论先天性肺隔离症术前诊断应注意结合胸片、碘油造影、逆行主动脉造影，一经诊断即应择期手术治疗，术中注意异常血管的处理。     

先天性肺囊性病变28例的诊断与治疗

目的 探讨儿童先天性肺囊性病变的诊断、手术时机和方式.方法 对儿童先天性肺囊性病变28例的临床资料进行回顾性分析.男19例,女9例;年龄1～12岁,平均5.4岁,其中1～5岁11例.先天性肺囊肿21例,其中支气管源性囊肿13例;肺源性囊肿6例;混合型2例.肺隔离症7例.术前诊断主要依靠胸部X线片和CT,术前确诊21例,其中先天性肺囊肿17例,肺隔离症4例.术前误诊7例,误诊率25%,其中误诊为肺脓肿、纵隔占位各2例,气胸、肺大疱、支气管扩张症各1例.行肺囊肿摘除术 3例,肺段切除术2例,肺叶切除17例,其中2例为急诊手术,隔离肺切除4例,双肺叶、肺叶加肺段切除术各1例.结果 本组无死亡病例,术后恢复良好,均痊愈出院,随访1～5 a,患儿生长发育及活动正常.结论 儿童先天性肺囊性病变误诊率高,诊断主要依靠影像学检查,确诊后应尽早手术,手术疗效满意,预后良好.     

小儿先天性肺隔离症的诊断与治疗

目的 探讨小儿先天性肺隔离症的诊断与治疗.方法 回顾性分析2001年3月至2011年3月收治的小儿先天性肺隔离症20例的临床资料.其中,男11例,女9例,年龄4 d～9岁(平均5.3岁),体重4～28 kg(平均11.3 kg).术前20例均行X线平片检查,15例加行普通CT平扫检查.误诊为肺囊肿9例,肺内肿瘤2例,漏诊4例在行其他手术时发现本病;另5例加行64层高速螺旋CT三维血管成像检查,发现有异常体动脉分支血管入隔离肺组织4例,高度疑诊本病1例.结果 全部20例均接受手术治疗,术后病理检查均证实为本病.术中发现病变肺组织(隔离肺)均有起自体动脉分支血管供血.本组均治愈,术后随访15例,随访2～7年,生长发育良好无复发,失访5例.结论 本病较少见,临床表现缺乏特异性,易被误诊和漏诊.高速螺旋CT 三维血管成像检查是术前确诊本病的重要手段.术中准确处理来自体动脉的分支血管是手术成功的关键.     

胸腔镜手术与开胸手术治疗先天性支气管囊肿的对比分析

目的总结传统开胸手术与胸腔镜手术治疗先天性支气管囊肿的经验,分析两种手术的可行性及优劣。方法回顾性分析本院自2013年1月至2叭5年11月收治的先天性支气管囊肿患儿临床资料。患儿均经产前超声检查获得初步诊断,经产前评估及出生后增强CT检查明确诊断,最后经手术确诊。手术方式分为传统开胸手术及胸腔镜手术,比较两组手术时间、术中出血量、住院时间及胸腔引流管留置情况,探讨小儿胸腔镜手术治疗支气管囊肿的可行性及风险。结果共13例确诊,12例手术,1例家属决定暂不手术。手术病例中,女性6例,男性6例,男:女=1:1。左右侧比为1:1,其中6例手术诊断为支气管囊肿,3例合并肺囊腺瘤,3例合并肺隔离症。5例术前准确诊断为支气管囊肿,7例诊断为肺囊腺瘤或肺隔离症。手术年龄最小5 d,最大1岁,平均手术年龄4.8个月。5例采取传统开胸手术;7例采取胸腔镜手术,其中1例2月龄患儿因术中须行肺叶切除而增加辅助切口。所有手术病例均治愈。结论先天性支气管囊肿属于少见疾病,由于存在感染以及占位的风险,建议早期手术。胸腔镜下操作,对于婴幼儿病例,不会增加手术风险,是一种可行的手术方式。     

先天性肺囊性疾病52例

目的 探讨儿童先天性肺囊性疾病的诊断、手术治疗方法及预后.方法 回顾性分析2003年1月至2012年6月在复旦大学附属儿科医院住院手术治疗的先天性肺囊性疾病儿童52例.对患儿临床表现、病变部位、影像学、病理学、漏诊误诊、手术治疗方法和短期肺功能进行统计分析.结果 52例先天性肺囊性疾病患儿中,男33例,女19例;年龄1 d～159个月,中位数为3.67个月;新生儿5例.病种:支气管源性肺囊肿42例,肺隔离症6例,大叶性肺气肿3例,先天性囊性腺瘤样畸形1例.临床表现以肺部感染为主,其中61.5％的患儿首次肺部感染后确诊,21.1％的患儿在反复呼吸道感染后确诊,约17.3％的患儿无症状.病变部位以右下肺最多见,约占36.5％.影像学以多发气囊肿最多见,约占42.3％.病理结果均提示支气管源性.漏诊率为17.3％,误诊率为24.9％,其中支气管源性肺囊肿误诊率为19.2％.治疗以肺叶切除术为主,无死亡病例.结论 小儿先天性肺囊性疾病的术前诊断主要依靠影像学检查,临床表现有助于早期识别,术前易漏诊误诊,术后病理有助于确诊,手术疗效肯定,预后好.     

小儿腹腔内肺隔离症4例并文献复习

目的探讨儿童腹腔内肺隔离症(intra-abdominal extralobar pulmonary sequestration,IEPS)的临床特征、病理类型、诊疗方法及预后情况,以提高对该病的认识及诊治水平。方法回顾性分析2007年6月至2018年6月首都医科大学附属北京儿童医院收治的4例腹腔内肺隔离症患儿临床资料;检索万方、维普、CNKI、Pubmed、Medline数据库截至2018年6月关于小儿腹腔内肺隔离症的相关文献,并进行分析。结果本研究4例腹腔内肺隔离症患儿,合并先天性肺气道畸形Ⅱ型/Ⅲ型(congenital pulmonary airway malformation type 2/type 3,CPAMⅡ/Ⅲ型)各2例,均行手术治疗,分别随访3个月、6个月、3年半、4年,预后良好。通过文献检索,检索到31篇儿童IEPS相关文献,联合本中心4例患儿分析结果如下:共47例患儿,44例产前发现病变时母亲孕龄为25周(IQR:12～37),46例产前经多普勒B超诊断腹腔肿物,10例怀疑神经母细胞瘤(neuroblastoma,NB),7例怀疑IEPS。5例终止妊娠。产后42例患儿中7例(7/42,16.7%)伴发先天畸形。术前主要经B超(30/38,78.9%)、增强CT(27/38,71.1%)明确诊断,其中11例误诊为NB,9例诊断为IEPS。5例行保守治疗,3例保守治疗无效后行手术治疗。共40例患儿行手术治疗,25例(25/40,62.5%)出生后6个月内行手术治疗,主要采用开腹手术(25/40,62.5%),3例行腹腔镜中转开腹手术。肿物主要位于左腹(32/40,80.0%)。手术切除肿物平均长径3.0(IQR:2.8～3.9)cm,供血来源主要为腹主动脉及其分支(16/21,76.2%)。术后病理检查均证实为肺隔离症,22例(22/40,55.0%)伴CPAM,其中12例伴CPAMⅡ型,2例伴CPAMⅢ型。所有患儿预后良好。结论产前超声对于小儿腹腔内肿物具有良好的诊断价值,但明确腹腔内肺隔离症仍需产后随访及综合评估。手术治疗是早期诊断IEPS的唯一方式,应根据病变选择合适的手术方案,完整切除肿物者预后良好。     

小儿先天性肺囊性腺瘤样畸形23例诊治分析

目的 总结小儿先天性肺囊性腺瘤样畸形(CCAM)的临床特点及诊治经验.方法 回顾性分析2001年3月至2007年12月在北京儿童医院经手术和病理检查确诊为CCAM的23例患儿的临床资料.所有患儿术前均摄X线胸片并行胸部CT扫描检查.结果 23例患儿中男15例,女8例.进行手术治疗时的平均年龄4.5岁,其中包括新生儿2例.术前诊断主要依靠病史和影像学检查.术前误诊4例,术前影像学检查确诊率为82.6%.依照Stocker组织病理学分型,23例患儿中Ⅰ型15例,Ⅱ型8例,没有恶变.23例均经手术治疗,证实1例为双侧痛变,余均为单侧病变和累及单叶.全部病例痊愈出院,随访结果显示23例均恢复良好.结论 小儿CCAM临床表现无特异性.影像学检查是发现该病的有效手段,确诊依据组织学检查,组织病理学分型可依据胸部CT结果得出大致判断.手术治疗是CCAM主要治疗手段,肺叶切除是标准术式并可取得良好的效果.     

Right pulmonary aplasia, aberrant left pulmonary artery, and bronchopulmonary sequestration with an esophageal bronchus

Pulmonary aplasia and bronchopulmonary foregut malformations in which a patent communication between the foregut and the pulmonary system is present are rare congenital abnormalities. Pulmonary aplasia associated with a pulmonary sling is an even rarer abnormality. We report a unique case of right pulmonary aplasia, aberrant left pulmonary artery, and bronchopulmonary sequestration with an esophageal bronchus diagnosed by multidetector helical CT.     

Intralobar pulmonary sequestration: an uncommon case with triple arterial supply and systemic venous drainage

Pulmonary sequestration is a rare congenital pulmonary malformation. We report a case of a 10-month-old infant with intralobar pulmonary sequestration diagnosed in utero. The lesion had an uncommon blood supply consisting of three large arteries deriving from the thoracic aorta and venous drainage into the inferior vena cava.     

Pulmonary sequestration in a newborn mimicking cardiac disease: a trap for diagnosis

A case of pulmonary sequestration in a neonate presenting with hyperdynamic circulation and a murmur is reported. Clinical, radiographic and echocardiographic data suggested the diagnosis and this was confirmed by angiography. The surgical findings were those of sequestration of the right lower lobe, in conjunction with an accessory right lung complete with bronchial and vascular supply arising from the region of the lower oesophagus. Pulmonary sequestration may mimic primary cardiovascular disease in the neonate.     

Congenital pulmonary extralobar intra-abdominal sequestration

Pulmonary sequestration is a rare congenital anomaly characterized by nonfunctioning embryonic pulmonary tissue that has no communication with the normal tracheobronchial tree. Pulmonary sequestration comprises 0.15% to 6.4% of all congenital pulmonary malformations and is divided into intralobar and extralobar types. The extralobar sequestration is rare, and comprises only 25% of all sequestrations. It is frequently associated with diaphragmatic hernia, eventration and other congenital anomalies. The authors report a case of extralobar retroperitoneal pulmonary sequestration which presented as adrenal tumour. The diagnosis was done by anatomo-pathological examination and no associated malformation was detected.     

Pulmonary sequestration in a newborn mimicking cardiac disease: A trap for diagnosis

A case of pulmonary sequestration in a neonate presenting with hyperdynamic circulation and a murmur is reported. Clinical, radiographic and echocardiographic data suggested the diagnosis and this was confirmed by angiography. The surgical findings were those of sequestration of the right lower lobe, in conjunction with an accessory right lung complete with bronchial and vascular supply arising from the region of the lower oesophagus. Pulmonary sequestration may mimic primary cardiovascular disease in the neonate.     

Torsed pulmonary sequestration presenting as a painful chest mass

Pulmonary sequestration is a congenital abnormality that can be divided into intralobar or extralobar types. Both types are characterized by pulmonary tissue that does not communicate with the bronchial tree or pulmonary arteries and typically has its arterial supply arising from the descending aorta. We report a case of an 11-year-old girl with extralobar sequestration who presented with torsion causing abdominal pain and pleuritic chest pain.     

小儿肺隔离症的临床诊疗进展

肺隔离症是一种先天性肺畸形,从解剖学的角度进行分类,包括叶内型肺隔离症和叶外型肺隔离症。影像学检查在肺隔离症的诊断中起着非常重要的作用,包括X线片、支气管碘油造影、彩色多普勒超声、磁共振成像和数字减影血管造影,而CT检查是目前最为常见且首选的诊断方式。手术仍然是肺隔离症的首选治疗方案。随着微创外科理念的普及,三孔胸腔镜、单孔胸腔镜以及机器人辅助肺叶或肺段切除术已在逐步探索和实践的过程中。本文就近年来小儿肺隔离症临床诊治进展作一综述,以期为小儿肺隔离症的临床诊疗提供参考。     

Intra-abdominal extralobar pulmonary sequestration presenting antenatally as a suprarenal mass

Extralobar pulmonary sequestration is a rare pulmonary parenchymal anomaly which rarely may be present in an intra-abdominal location. The authors report a case of intra-abdominal extralobar pulmonary sequestration which presented to us as an antenatally diagnosed suprarenal mass and was worked up as such. The diagnosis was revealed only at laparotomy. Intra-abdominal extralobar pulmonary sequestration should also be kept in differential diagnosis in cases of masses in the suprarenal location, especially on the left side.     

The significance of lung scintigraphy in anomalies of the pulmonary vascular bed

Aplasia, hypoplasia and stenosis of the pulmonary artery showed, on scintigraphic investigation, unilateral, homogenous decreased in lung perfusion. In 3 of 4 children with pulmonary sequestration there was a difference in blood flow between the two lungs, or in one part of the lung. Isolated anomalous drainage of pulmonary veins does not produce deviations from the normal distribution of blood flowing from the right ventricle into the lungs. Analysis of scinitigraphic findings in 1450 children with cardiopulmonary disease has shown that with an otherwise unexplained marked homogeneous unilateral decrease in flow, we can with great certainty diagnose a developmental defect of the pulmonary vessels. Differences in lung area, judged from the scintigram, are a sensitive indicator of associated disturbances of development of the lung parenchyma. In 26 of 42 such developmental anomalies of the pulmonary vascular bed this finding was demonstrated. Pulmonary scintigraphy is a very valuable complementary method, because of its simplicity and relative safety for the patient, in the diagnosis of congenital anomalies of the pulmonary vasculature, especially in infants and young children.     

闭塞性细支气管炎31例

目的 明确小儿闭塞性细支气管炎(BO)的临床特点、治疗措施及随访结果.方法 对2008年4月- 2011年6月在本科明确诊断为BO患儿的临床资料进行归纳、总结,对其治疗效果进行随访分析.结果 31例患儿反复咳嗽及喘息均＞6周,查体肺部听诊可闻及哮鸣音和(或)粗湿啰音.入院给予雾化吸入支气管扩张剂无反应.31例患儿均存在肺功能异常,24例患儿为阻塞性通气功能障碍,7例患儿肺功能示混合性通气功能障碍;31例肺CT均存在Mosaic灌注征、双肺均可见斑片状密度增高影,肺不张6例,支气管壁增厚5例,支气管扩张2例.31例X线胸片均有过度通气表现,可见斑片状密度增高影,4例呈毛玻璃样改变.患儿均口服泼尼松、阿奇霉素并配合雾化吸入布地奈德及沙丁胺醇.对其中26例患儿进行2个月～3 a随访,规律治疗的6例患儿临床症状明显改善,无明显喘息发作,活动耐力好转,复查肺部高分辨率CT示肺部病变明显改善;10例临床症状略好转,仍有活动后气促,复查肺部高分辨率CT示肺部病变轻微改善;10例患儿依从性差,未按医嘱规律用药及回访,病情经常反复,于呼吸道感染后出现喘息发作,于本院住院3～6次,临床疗效欠佳,复查肺部高分辨率CT示肺部病变无改善,现仍在随访中.结论 BO大多为肺部感染后引起的反复咳嗽、喘息,肺部听诊可闻及明显的呼气相哮鸣音,吸入支气管扩张剂效果不佳,肺功能大多表现为阻塞性通气功能障碍,CT可见肺部典型的Mosaic灌注征.本病预后不佳.