先天性肺囊性病的诊断和手术治疗

目的总结儿童先天性肺囊性病的诊治经验,探讨手术时机和方式。方法1993年1月至2006年5月,手术治疗52例先天性肺囊性病患儿,男26例,女26例,平均年龄3．5岁,包括新生儿16例。术前诊断主要依靠X线胸片和胸部CT。病种包括：先天性肺囊肿37例,先天性肺大叶气肿6例,肺隔离症10例。肺囊肿行肺叶切除27例、囊肿摘除8例、肺楔形切除2例;肺大叶气肿中5例有呼吸窘迫,均行肺叶切除术。肺隔离症中包括叶内型3例,叶外型7例,均手术切除。结果无手术死亡,近期主要并发症包括反复气胸1例、少量胸腔积液1例、肺炎2例。所有病人均痊愈出院。随访病人中1例肺囊肿复发,术后3年再次行左下肺叶切除术。其余病人均恢复良好,肺功能正常。结论小儿先天性肺囊性病应早诊断、早手术,对有明显压迫症状和呼吸窘迫者应急诊手术。手术是先天性肺囊性病的主要治疗方法,肺叶切除是标准术式,术后肺功能均可恢复。

Congenital cystic lung lesions: diagnosis and surgical management

Purpose To review the thirteen-year-experience of diagnosis and surgical management for congenital cystic lung disease in children. Methods From January 1993 to May 2006, 52 patients with congenital cystic lung disease underwent surgical treatment, including lung cyst in 37 patients, congenital lobar emphysema in 6 and pulmonary sequestration in 10 (intralobar in 3 and extralobar in 7). There were 26 males and 26 females. Mean age at operation was 3. 5 years and 16 patients were under one month of age. The preoperative diagnosis was on the basis of history, clinical presentation, chest X-ray and/or computerized tomography. Among the 37 patients with lung cyst, 27 underwent lo-bectomy, 2 had wedge resection and 8 patients required excision of the cyst. Five of six patients with congenital lobar emphysema presented with respiratory distress preoperatively thus required emergent operation. For patients with intralobar and extralobar sequestration, lobectomy and sequestrectomy were performed respectively. Results There were no operation deaths. Early postoperatively, one patient presented with recurrent pneumothorax, one had mild pleural effusion and two had pneumonia. All the patients recovered well. During follow-up, there was recurrent pulmonary cyst in one patient, who underwent left lower lobectomy three years after the previous operation. Others were doing well and maintained good lung function. Conclusions Early diagnosis and prompt management are required for congenital cystic lung disease in children. Surgical resection, commonly lobectomy, is the main treatment for this lesion. Urgent or emergent operation is needed in symptomatic patients with respiratory distress. An excellent lung function following surgery can be expected.