摘要
目的探讨婴儿先天性肺囊性畸形肺切除手术的病因、手术适应证、诊断方法及围手术期处理。方法回顾性分析2008年1月至2012年12月因肺囊性发育畸形而行肺切除手术56例患儿的临床资料。其中，男41例，女15例；年龄5d～11个月（平均120d）。先天性肺囊肿24例、先天性大叶性肺气肿11例、先天性囊性腺瘤样畸形16例、叶内型隔离肺5例。本组诊断年龄5d～11个月，平均120d。因呼吸窘迫手术25例（44％），因呼吸道感染手术28例（51％），因胸部x线检查发现无症状囊性病灶手术3例（5％）。手术方式为肺叶切除18例，病灶切除或肺段切除38例。结果全组手术均在静脉复合麻醉＋单侧肺通气（支气管堵闭器）下进行，术程顺利，除1例因残余病变行二次手术，余55例患儿均恢复良好。全部患儿在门诊随访，随访时间4个月～4年，平均1年5个月。全部患儿存活，无肺部相关症状，情况稳定。生长发育、活动量均与正常同龄儿无异。结论伴随症状的先天性肺囊性畸形患儿一旦明确诊断，应尽快施行外科手术治疗；有严重呼吸窘迫的患儿应急诊手术。术中根据实际情况选择肺叶或肺段切除术。对患有先天性肺囊性畸形患儿，如能早期诊断并及时采取外科治疗，可获得满意疗效。
Objective To explore the causes, surgical indications, diagnostic modalities and perioperative treatments of congenital cystic lung lesions through lung resection. Methods Retrospective analyses were performed for 56 infants undergoing lung resection for congenital cystic lung lesions between January 2008 and December 2012. There were 41 males and 15 females with a mean diagnostic age of 120 （5-330） days. The lesions included congenital pulmonary cyst （n = 24）, congenital lobar emphysema （n = 11）, congenital cystic adenomatoid malformation （n = 16） and pulmonary sequestration （n = 5）. The clinical presentations included respiratory distress （n = 25, 44%）, respiratory infection （n = 28, 51%） and asymptomatic cystic lesions （n = 3, 5%）. Lobectomy （n = 18） and segmentectomy or cyst removal （n = 38） were performed. Results Surgery was performed under single-lung ventilation after intravenous anesthesia. All operations were uneventful. One case underwent a second operation because of residual malformation. The remainder recovered well. The median length of follow-up was 17 （4-48） months. There was no instance of complications or physical limitations during follow-ups. Conclusions When a definite diagnosis of symptomatic congenital cystic lung lesion is made, lung resection should be performed as soon as possible and emergency operation is indicated for those with severe respiratory distress. Wedge-type or segment lobectomy should be performed according to the conditions of infants. Early diagnosis and timely operation are essential, especially for those with progressive respiratory failure.
出处
《中华小儿外科杂志》
CSCD
北大核心
2014年第3期191-194,共4页
Chinese Journal of Pediatric Surgery
关键词
婴儿
畸形
肺切除术
Infant Abnormalities Pneumonectomy
