30例儿童肺隔离症回顾分析

发布时间：2018-06-07 04:08

本文选题：儿童 + 肺隔离症　；参考：《重庆医科大学》2014年硕士论文

【摘要】：目的探讨并归纳总结儿童肺隔离症的临床特点、诊断、治疗及预后,提出最佳诊断及治疗方式。方法回顾性分析重庆市儿童医院1994年4月-2013年4月肺隔离症的临床资料，并使用统计软件SPSS19.0比较叶内型及叶外型的临床特征有无差异。结果 1我院共收治确诊肺隔离症30例。其中男12例，女18例，性别比例为1:1.5。首诊年龄13天1小时~14岁不等，平均诊断年龄52.4±49.3月。其中~28天：1例（3.3%），~1岁：6例（20%），~3岁：10例（33.3%），~6岁：4例（13.3%），~13岁：8例（26.7%），13岁：1例（3.3%）。 227例（90%）表现出非特异性症状：发热21例（70%）、咳嗽20例（66.7%）、咳痰/喉间痰响13例（43.3%）发热+咳嗽：16例（53.3%），发热+咳痰/喉间痰响：12例（40%），发热+咳嗽+咳痰/喉间痰响：10例（33.3%）,咳嗽+咳痰/喉间痰响：10例（33.3%）。无症状体检发现者3例(10%)。21例（70%）体征有异常，15例（50%）患侧呼吸音减低，6例（20%）可闻及少许粗/中湿罗音，9例（30%）无阳性体征。 3行胸片19例，胸部彩超13例，胸部CT平扫26例/CT增强6例/CT增强+血管三维重建9例，主动脉逆行造影3例，纤支镜1例。术前确诊16例（53.3%），确诊手段：CT增强+血管三维重建（9例）、CT增强（4例）、DSA（3例）。术前漏诊3例(10%)，均因合并肺囊肿，于肺叶切除术中发现。术前误诊11例(45.8%)，误诊为肺囊肿8例，肿瘤2例，肺大泡1例。 424例行手术切除，2例行介入堵闭术,4例行保守治疗。叶内型17例（男6例，女11例），平均首诊年龄（58.9±53.7月），临床无症状1例（体检发现），阳性体征12例，发病部位：左下肺叶（9例）、右下肺叶（8例），合并畸形5例（29.4%），异常血管支数:1支（14例）、2支（1例）、5支（1例）、不详（1例），异常血管来源：胸主动脉（14例）、腹主动脉（1例）、肋间动脉（1例）、不详（1例），静脉引流情况：左下肺静脉（7例）、右下肺静脉（8例）、不详（2例），术后住院时间平均10.4±1.9天，置管时间平均3.6±1.0天。叶外型7例（男3例，女4例），平均首诊年龄（31.4±29.1月），无症状1例（孕24周彩超发现），阳性体征7例，均表现为患侧肺呼吸音降低。发病部位：左肋膈角（5例）、右肋膈角（2例），合并畸形4例（57.1%），异常血管支数:1支（6例）、不详（1例），异常血管来源：胸主动脉（5例）、腹主动脉（1例）、不详（1例），静脉引流情况：左下肺静脉（2例）、奇静脉（1例）、不详（4例），术后住院时间平均9.3±1.3天，置管时间平均3.0±0.9天。 5术中无死亡发生，术后见1例合并包裹性胸腔积液，手术患儿均治愈出院。慢性炎症和肺发育不良为术后病检的主要表现。1例因抗酸染色找到结核杆菌，，诊断合并肺结核。手术及介入患儿术后成功随访18例（其中2例为介入患儿），均无反复肺部感染或其它并发症发生。结论 1儿童PS多发生于左肺，多于13岁之前出现临床症状，常表现为反复呼吸道感染，症状不典型，漏诊误诊率高，易与肺囊肿、肺炎、肺部肿瘤等相混淆，临床医师尤其是儿科医师急需提高对该病的认知度。 2儿童PS叶内型与叶外型在性别、首诊年龄、症状、两肺的发生率、合并畸形率、异常血管来源及支数、术后住院时间及置管时间上均无明显差异，仅通过临床分型较困难，但叶外型较叶内型更易出现患侧肺部呼吸音减低，叶内型较叶外型更易合并多种畸形。肺囊肿和先天性心脏病为PS最常见合并畸形。静脉多回流入下肺静脉。ELS多位于肋膈角处，ILS多见于肺下叶，尤其是左肺下叶。 3发现异常体循环供血动脉是确诊PS关键，胸片及彩超可作为PS患儿的常规筛查，胸部CT血管三维重建为确诊首选，对确诊的PS患儿，做胃肠道钡餐、心脏彩超等检查排除合并先天性心脏病、膈疝、支气管胃瘘及食管气管瘘等畸形很有必要，超声检查在新生儿和产前诊断方面有应用价值。 4PS一旦确诊，均应手术治疗， ILS主要采用肺叶切除术，而ELS常可仅切除病灶，术前未分型或动静脉走形显示不清并非手术绝对禁忌症。手术安全，术中死亡及术后并发症少见。术后病检可排除是否合并真菌、结核感染甚至恶性变等。
[Abstract]:Objective to explore and summarize the clinical characteristics, diagnosis, treatment and prognosis of children with pulmonary sequestration, and propose the best diagnosis and treatment.
Methods the clinical data of pulmonary sequestration in Chongqing children's Hospital in April 1994 -2013 April were analyzed retrospectively, and the statistical software SPSS19.0 was used to compare the clinical characteristics of the inner leaf type and the leaf type.
Result
1 there were 30 cases of confirmed pulmonary sequestration in our hospital, of which 12 cases were male and 18 women. The sex ratio was 13 days, 1 hours, 1 hours, 13 days and 1 hours. The average diagnostic age was 52.4 + 49.3 months. Among them, ~28 days were 1 (3.3%), 6 (20%), 10 cases (33.3%), ~6 years old, ~13 years old.
227 cases (90%) showed non specific symptoms: fever 21 cases (70%), cough 20 cases (66.7%), expectoration / laryngeal phlegm (43.3%) fever + cough: 16 cases (53.3%), fever + expectoration / laryngeal phlegm: 12 (40%), fever + cough + expectoration / laryngeal phlegm ringing: 10 cases (33.3%), cough + expectoration / laryngeal phlegm ringing: asymptomatic physical examination Discoverers .21 (70%) had abnormal signs, 15 cases (50%) had lower respiratory sounds, 6 cases (20%) could hear a little coarse / medium rales, and 9 cases (30%) had no positive signs.
19 cases of 3 lines of chest, 13 cases of chest color Doppler ultrasound, 26 case of chest CT scan, 6 cases of enhanced /CT and three-dimensional reconstruction of blood vessels, 3 cases of aortic retrograde angiography and 1 cases of fiberoptic bronchoscopy (53.3%), CT enhanced + vascular three-dimensional reconstruction (53.3%), CT enhancement (4), DSA (3 cases), pulmonary cysts and lobectomy 11 cases (45.8%) were misdiagnosed before operation, 8 cases were misdiagnosed as pulmonary cysts, 2 cases were tumors, and 1 cases were pulmonary bullae.
There were 424 cases of surgical excision, 2 cases of interventional occlusion and 4 cases of conservative treatment. 17 cases (6 men, 11 cases), the average age of first diagnosis (58.9 + 53.7 months), clinical asymptomatic 1 cases (physical examination), 12 cases of positive signs, the location of the left lower lobe (9), the right lower lobe (8), complicated 5 cases (29.4%), abnormal vascular support 5 (1 cases), unknown (1 cases), abnormal vascular sources: thoracic aorta (14 cases), abdominal aorta (1 cases), intercostal artery (1 cases), unknown (1 cases), venous drainage: left inferior pulmonary vein (7 cases), right lower pulmonary vein (8 cases), not detailed (2 cases), postoperative hospital time average 10.4 + 1.9 days, the average catheter time 3.6 + 1 days. The mean first diagnosis age (31.4 + 29.1 months), 1 cases of asymptomatic (24 Zhou Caichao pregnancy) and 7 cases of positive signs were manifested as decreased respiratory sound in the lateral lung. The site of the disease: left rib diaphragm (5 cases), right rib diaphragm (2 cases), 4 cases (57.1%) with abnormal vascular malformation, 1 branches (6), abnormal vascular sources: thoracic aorta (5 cases), abdominal aorta (1) Cases (1 cases), venous drainage: left inferior pulmonary vein (2 cases), odd vein (1 cases), unknown (4 cases), the average time of postoperative hospitalization was 9.3 + 1.3 days, the average time of catheterization was 3 + 0.9 days.
No death occurred during the 5 operation. 1 cases were combined with encapsulated pleural effusion after operation. All the children were cured and discharged from the operation. Chronic inflammation and pulmonary dysplasia were the main manifestations of postoperative disease detection in.1 cases. The diagnosis of tuberculosis with acid staining was found. 18 cases (2 of them were intervened) after operation and intervention. Pulmonary infection or other complications.
conclusion
1 children with PS were mostly born in the left lung, which had clinical symptoms before 13 years old, often manifested as recurrent respiratory infection, the symptoms were not typical, the misdiagnosis rate was high, and it was easy to be confused with the lung cysts, pneumonia, lung tumor and so on. The clinicians, especially the pediatrician, were in urgent need of improving the recognition of the disease.
2 the PS leaf type and outer leaf type in children had no obvious difference in sex, first diagnosis age, symptom, two lung incidence, combined malformation rate, abnormal blood vessel source and number, no obvious difference in postoperative hospital time and time of intubation. Pulmonary cysts and congenital heart diseases are the most common deformities of PS. More than.ELS in the inferior pulmonary veins are located at the costal angle, and the ILS is more common in the lower lobe of the lung, especially in the left lower lobe.
3 it is found that abnormal circulation of blood supply artery is the key to diagnosis of PS. Chest and color Doppler ultrasound can be used as routine screening for children with PS. The three-dimensional reconstruction of CT vessels in the chest is the first choice. It is necessary to exclude congenital heart disease, diaphragmatic hernia, bronchostomy fistula and esophagotracheal fistula in the diagnosis of PS children, gastrointestinal barium meal, heart color Doppler ultrasound and so on. Sound examination is valuable in the diagnosis of neonatal and prenatal diagnosis.
Once the 4PS is confirmed, all of them should be operated on. ILS mainly adopts lobectomy, and ELS can only be excised only. The preoperative undivided or arteriovenous malformation is not an absolute contraindication. The operation is safe, the intraoperative death and postoperative complications are rare.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R725.6

【参考文献】