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目的探讨肺隔离症患者的临床特点、影像、病理特征及治疗,减少误诊。方法回顾性分析2008年2月至2014年6月浙江大学医学院附属第一医院诊断明确的43例肺隔离症患者的临床影像及病理资料。结果 43例患者中男27例,女16例。平均年龄(38±14)岁。主要临床表现为反复咳嗽、咳痰、发热、咯血或痰血。CT表现为实性肿块影21例,囊性病灶13例,囊实性病灶7例,肺不张2例。26例经影像学检查诊断。手术治疗40例,其中37例行胸腔镜肺叶切除术。手术证实叶内型36例,叶外型4例。组织病理学检查提示肺发育不良及慢性炎症改变。保守治疗3例。结论肺隔离症以肺组织发育不良及异常动脉供血为特征,临床症状缺乏特异性,影像表现具有多样性,以实性肿块影最多见,囊性病灶次之。确诊肺隔离症可以首选增强CT结合血管成像三维重建。治疗推荐尽早手术,胸腔镜微创手术证实是安全可行的治疗模式。
Objective To investigate the clinical features, imaging, pathological features and treatment of patients with pulmonary sequestration and to reduce misdiagnosis. Methods The clinical imaging and pathological data of 43 patients with pulmonary sequestration diagnosed in the First Affiliated Hospital of Zhejiang University from February 2008 to June 2014 were retrospectively analyzed. Results There were 27 males and 16 females in 43 cases. The average age (38 ± 14) years old. The main clinical manifestations of repeated cough, sputum, fever, hemoptysis or sputum blood. CT showed solid mass in 21 cases, cystic lesions in 13 cases, cystic solid lesions in 7 cases, 2 cases of atelectasis. 26 cases diagnosed by imaging examination. Surgical treatment of 40 cases, 37 cases of thoracoscopic lobectomy. Surgery confirmed 36 cases of leaf type, leaf shape in 4 cases. Histopathological examination suggests that lung dysplasia and chronic inflammation change. Conservative treatment in 3 cases. Conclusion Pulmonary sequestration is characterized by dysplasia of lung tissues and abnormal arterial blood supply. The clinical symptoms are not specific and the images are diverse. Most of them are cystic lesions followed by cystic lesions. Confirmed diagnosis of pulmonary sequestration can be the first choice of enhanced CT combined angiography 3D reconstruction. Treatment recommended early surgery, minimally invasive thoracoscopic surgery proved to be safe and feasible treatment mode.