CAJ | 학술논문

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120 d).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.
목적 탐토영인선천성폐낭성기형폐절제수술적병인、수술괄응증、진단방법급위수술기처리.방법 회고성분석2008년1월지2012년12월인폐낭성발육기형이행폐절제수술56례환인적림상자료.기중,남41례,녀15례;년령5d～11개월(평균120 d).선천성폐낭종24례、선천성대협성폐기종11례、선천성낭성선류양기형16례、협내형격리폐5례.본조진단년령5d～11개월,평균120d.인호흡군박수술25례(44％),인호흡도감염수술28례(51％),인흉부X선검사발현무증상낭성병조수술3례(5％).수술방식위폐협절제18례,병조절제혹폐단절제38례.결과 전조수술균재정맥복합마취+단측폐통기(지기관도폐기)하진행,술정순리,제1례인잔여병변행이차수술,여55례환인균회복량호.전부환인재문진수방,수방시간4개월～4년,평균1년5개월.전부환인존활,무폐부상관증상,정황은정.생장발육、활동량균여정상동령인무이.결론 반수증상적선천성폐낭성기형환인일단명학진단,응진쾌시행외과수술치료;유엄중호흡군박적환인응급진수술.술중근거실제정황선택폐협혹폐단절제술.대환유선천성폐낭성기형환인,여능조기진단병급시채취외과치료,가획득만의료효.
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.