CAJ | 학술논문

目的胎儿先天性大叶性肺气肿(CLE)的产前超声很容易与肺囊腺瘤Ⅲ型(CCAMⅢ)混淆,因为二者均表现为同一血供的高回声囊性肿块,产前超声难以鉴别.由于二者的临床结局不同,为提高对CLE的认识,结合新生儿的结局探讨胎儿CLE的诊断和治疗.方法回顾性分析广东省妇幼保健院胎儿医学科2011年3月至2013年5月产前诊断和出生后确诊为CLE的诊治经验.结果在胎儿产前超声诊断为胸部囊性病变的基础上,52例确诊为CCAMⅢ,其中6例(11％,6/52例)于出生后CT确诊为CLE,5例于出生后早期手术,术后病理组织诊断.6例中3例出生后即出现急性呼吸道症状,2例于新生儿期急诊手术治愈,1例放弃治疗;另3例分别于出生后第7天、第19天及3个月出现呼吸道症状行手术治愈.所有受累部位以上肺叶为主(83％,5/6例).手术肺叶切除部位分别为左上肺叶2例,右上肺1例,右上肺叶和右中肺叶1例,右下肺叶1例.手术年龄3～90 d,平均20 d.手术病例均治愈.结论产前胎儿CLE与CCAMⅢ型在超声上尚无法鉴别,但出生时或出生后较早出现呼吸道症状并导致新生儿急诊和治疗;CT可明确诊断.以往认为的CCAMⅢ预后差是否为将CLE误诊为CCAMⅢ,需要重新认识;对于CLE新生儿急性呼吸道症状者行新生儿外科治疗是积极有效的.
목적 태인선천성대협성폐기종(CLE)적산전초성흔용역여폐낭선류Ⅲ형(CCAMⅢ)혼효,인위이자균표현위동일혈공적고회성낭성종괴,산전초성난이감별.유우이자적림상결국불동,위제고대CLE적인식,결합신생인적결국탐토태인CLE적진단화치료.방법 회고성분석광동성부유보건원태인의학과2011년3월지2013년5월산전진단화출생후학진위CLE적진치경험.결과 재태인산전초성진단위흉부낭성병변적기출상,52례학진위CCAMⅢ,기중6례(11％,6/52례)우출생후CT학진위CLE,5례우출생후조기수술,술후병리조직진단.6례중3례출생후즉출현급성호흡도증상,2례우신생인기급진수술치유,1례방기치료;령3례분별우출생후제7천、제19천급3개월출현호흡도증상행수술치유.소유수루부위이상폐협위주(83％,5/6례).수술폐협절제부위분별위좌상폐협2례,우상폐1례,우상폐협화우중폐협1례,우하폐협1례.수술년령3～90 d,평균20 d.수술병례균치유.결론 산전태인CLE여CCAMⅢ형재초성상상무법감별,단출생시혹출생후교조출현호흡도증상병도치신생인급진화치료;CT가명학진단.이왕인위적CCAMⅢ예후차시부위장CLE오진위CCAMⅢ,수요중신인식;대우CLE신생인급성호흡도증상자행신생인외과치료시적겁유효적.
Objective Fetal congenital lobar emphysema (CLE) is generally confused with congenital cystic adenomatoid malformnation type Ⅲ (CCAM Ⅲ) by prenatal ultrasound as both are hyperechoic cystic mass with the same blood supply,which is difficult to differentiate through the prenatal ultrasound.As they have different clinical outcomes,and in order to improve the understanding of CLE,the diagnosis and treatment of neonatal outcome of fetal CLE were discussed.Methods A retrospective analysis was conducted of the experience in prenatal diagnosis and treatment of postnatal CLE at Department of Fetal Medicine,Guangdong Women and Children's Hospital from Mar.2011 to May 2013.Results On the basis of prenatal ultrasound for fetal chest cystic malformations,there were 52 cases of CCAM Ⅲ in which 6 cases(11％,6/52 cases) were confirmed as CLE by CT scan after birth and 5 cases had early operation.Emphysema was detected in all pathological specimens.Of 3 cases presenting symptoms of tachypnea after birth,2 had acute lobectomy and 1 gave up therapy.The other 3 cases underwent lobectomy on 7 day,19 day and 3 months respectively after birth because of tachypnea and respiratory distress.The most common affected lobe was the upper lobe (83％,5/6 cases).The lobectomy included 2 left upper lobe,1 right upper lobe,1 right upper and middle lobe,and 1 right lower lobe.The mean age of lobectomy was 20 days(from 3 to 90 days).All the cases were cured through lobectomy.Conclusions Prenatal CLE can not be differentiated from CCAM Ⅲ on ultrasound,but it exhibited early pulmonary distress at birth or after birth leading to neonatal emergency and treatment.h can be confirmed by computed tomography scan.Previously CCAM Ⅲ prognosis was thought to be poor and it remains unconfirmed whether CLE had been misdiagnosed as CCAM]Ⅲ need to know.For the CLE with neonatal acute respiratory symptoms early surgical treatment is effective.