摘要
目的对直视下隔离肺肺叶切除术、经胸腔镜下隔离肺肺叶切除、经皮导管介入侧支血管封堵术3种手术方式结果进行回顾性分析。方法 1995年10月至2014年5月,广东省人民医院分别采用直视下隔离肺肺叶切除术、经胸腔镜下隔离肺肺叶切除、经皮导管介入侧支血管封堵术治疗隔离肺患者共31例,按相应手术方式的分为A组19例、B组7例和C组5例,比较不同组患者的手术成功率、手术时间、术后并发症的发生率、术后住院时间、出血及输血总量等情况。结果A组19例均成功切除隔离肺,术后出现1例胸腔内大出血,3例气胸;B组7例均成功切除隔离肺,术后出现胸腔内大出血1例;C组4例使用血管塞的患者成功封堵供应隔离肺的侧支血管,1例因使用弹簧圈后复发。C组手术时间、术中出血量、术后并发症的发生率、术后住院时间明显少于A组,差异有统计学意义(P<0.05);C组的术中出血量、术后并发症发生率明显少于B组,差异有统计学意义(P<0.05);但手术时间无明显减少,差异无统计学意义(P>0.05)。B组的手术时间比A组明显减少,差异有统计学意义(P<0.05);但术中出血量、术后住院时间无明显减少,差异无统计学意义(P>0.05)。3组的术后输血量比较,差异无统计学意义(P>0.05)。C组手术成功率低于A组及B组,差异有统计学意义(P<0.05)。结论 3种手术方式均可有效治疗肺隔离症。经皮导管介入体肺侧支血管封堵术操作简便,全身组织损伤小,术后并发症少,但成功率稍低。直视下隔离肺肺叶切除术、经胸腔镜下隔离肺肺叶切除术成功率高,但手术时间长,术后并发症、术后住院时间、出血量及输血总量明显多于导管介入封堵侧支血管术,但适应证广(尤其是肺隔离症合并其他畸形者)。临床工作中,我们应当根据患者的具体病情和需求选择合适的治疗方式,但符合介入治疗条件的患者,应首选介入治疗。
Objectives To retrospectively analyze the outcomes of three kinds of operational approaches for pulmonary sequestration,including lung lobectomy,thoracoscopic lung lobectomy and percutaneous transcatheter occlusion for pulmonary collateral vessels. Methods There were 31 case with pulmonary sequestration who accepted different operational approaches in Guangdong General Hospital from October 1995 to May 2014. These 31 cases were divided into three groups according to the kinds of operational approaches ：19 cases with lung lobectomy were in group A, 7cases with thoracoscopic lung lobectomy were in group B and 5 cases with percutaneous transcatheter occlusion for pulmonary collateral vessels were in group C. Their success rates,operation durations,incidences of postoperative complications,postoperative hospital stay,total amount of bleeding and blood transfusion were compared in different groups. Results Nineteen cases in group A were successfully performed lung lobectomy, of which, 1 case was found postoperative chest bleeding and 3 cases were found pneumothorax. Seven cases in group B were successfully performed thoracoscopic lung lobectomy, of which, 1 case was found postoperative chest bleeding. Four cases in grouop C were successfully used vascular plug, and 1 case failed by using coil spring. Operation duration, intraoperative blood loss,incidence of postoperative complications and postoperative hospital stay in group C were significantly lower than those in group A（P〈0.05）; intraoperative blood loss and incidence of postoperative complications in group C were significantly lower than those in group B（P〈0.05）, but operation duration had no significant difference between group C and group B（P〉0.05）. Operation duration in group B was significantly lower than that in group A（P〈0.05）, but intraoperative blood loss and postoperative hospital stay were not significantly lower in group B compared with those in group A（P〉0.05）. Postoperative blood transfusion showed no significant difference among the three groups（P〉0.05）, but success rate in group C was significantly lower than those in group A and group B（P〈0.05）. Conclusions The three kinds of operational approaches are effective in the treatment of pulmonary sequestration. Percutaneous transcatheter occlusion for pulmonary collateral vessels is easy for operator, has fewer damages and fewer postoperative complications, but the success rate is lower. Lung lobectomy and thoracoscopic lung lobectomy have higher success rates and wider indications（especially for pulmonary sequestration associated with other malformations）, but the operation durations, postoperative complications, postoperative hospital stay, blood loss and blood transfusion were significantly higher than those in percutaneous transcatheter occlusion for pulmonary collateral vessels. In clinical work, we should choose the right treatment according to the patient＇s specific conditions and needs, but for those who meet the criteria, intervention should be the prior approach.
出处
《岭南心血管病杂志》
2015年第2期187-190,共4页
South China Journal of Cardiovascular Diseases
关键词
肺隔离症
肺叶切除术
经胸腔镜下隔离肺肺叶切除
经导管介入体肺侧支血管封堵术
pulmonary sequestration
lobectomy
thoracoscopic lung lobectomy
percutaneous transcatheter occlusion for pulmonary collateral vessels
