【摘要】 目的 分析总结肺隔离症（PS）的临床诊断及治疗方法。 方法 回顾分析2000年2月-2009年10月确诊的27例PS患者临床特征、诊断方法及治疗手段。 结果 27例PS患者均经影像学和手术确诊，其中叶内型22例，叶外型5例，行左下肺切除17例，右下肺切除10例；全部手术切除。术后并发胸腔积液1例，肺不张2例，分别给予穿刺抽液、纤维支气管镜吸痰等积极治疗后痊愈，其余患者恢复较好，随访6~60个月无复发。 结论 PS手术前误诊率高，诊断方法主要为X线平片、CT及CT增强血管照影（CTA）检查。CTA可显示异常供血动脉，是诊断PS的首选检查方法。一经明确诊断应尽早给予治疗，治疗方案主要包括手术和螺圈栓塞。【Abstract】 Objective To summary the diagnosis and therapy of pulmonary sequestration. Methods Clinical symptoms, methods of diagnosis and treatments of 27 patients diagnosed with pulmonary sequestration from February 2002 to October 2009 were analyzed retrospectively. Results Twenty-seven patients were all confirmed by imaging and surgery, and had undergone surgical excision. Twenty-two patients were with intralober pulmonary sequestrateon (IPS) and five were with extralober pulmonary sepuestration (EPS); 17 patients were treated by left lower lobectomy, and 10 patients required right lower lobectomy. After the surgery, there were one patient with pleural effusion and two patients with atelectasis who suffered from complications postoperatively, and they were healed by symptomatic treatment. The rest recovered well. There were no recurrence from six to 60 months follow-up. Conclusion Pulmonary sequestration may be misdiagnosed easily. The main methods for the examination include X-ray,CT and CTA. CTA can detect anomalous systemic artery,which should be the first choice in diagnosing of pulmonary sequestration. Surgery and coil embolization are the main treatments. Once being confirmed,pulmonary sequestration should be treated as soon as possible.
Objective To find effective ways for controlling the hospital infection to the skeptical gas gangrene patients. Method From May 14th to June 24th, the hospital set up triage spots originally and dealt with the wounded based on their specific conditions in different stages and optimized the flow of admission of the wounded. Owing to correctly treating the wound and screening the skeptical gas gangrene patients, preventing nosocomial infections was shifted forward. Sprending the gas gangrene wound after having flushed it with 3% H2O2. If the wound have been stitched, the stitches should bee taken out, and open the wound and take the debridement for it completely, then treat it with b antibacterial after debridement by sterilization and isolation about operation of gas gangrene. Result Up to June 24th, none of 67 cases of doubtful gas gangrene from the disaster area died and no hospital cross infections happened in courtyard. At present, amomg the 67 cases, 32 were highly suspected of gas gangrene infection, 26 cases were discharged, while 6 cases were undergoing treatment in the hospital. Conclusion Correct management and appropriate treatment are effective ways for controlling hospital cross infection to the skeptical gas gangrene patients.
目的 总结肺隔离症的临床特点、诊断方法及治疗的经验，降低误诊率，提高治疗水平。 方法 回顾性分析福州总医院2002年7月－2012年6月收治的27例肺隔离症患者的临床诊治手段。 结果 27例肺隔离症患者中，术前确诊仅有18例，误诊为肺部良性肿瘤3例，肺脓肿3例，支气管扩张2例，纵隔肿瘤1例。行外科切除的患者有19例，其中13例经胸腔镜手术，6例开胸手术，均无复发；行支气管动脉数字减影血管造影栓塞术8例，其中再发咯血1例来院行手术治疗。 结论 外科治疗是目前肺隔离症治疗的主要方法。围手术期积极控制感染对治疗的成功有显著意义。
ObjectiveTo explore the safety and feasibility of uni-portal video-assisted thoracic surgery (VATS) for the treatment of bronchopulmonary sequestration (BPS). MethodsThe clinical data of BPS patients with surgical resection in Shanghai Pulmonary Hospital from February 2010 to June 2021 were reviewed. The patients were divided into a VATS group and a thoracotomy group according to the operation method. The operation time, intraoperative blood loss, hospital stay and postoperative complication rate were compared between the two groups. The VATS group was subdivided into a uni-portal VATS group and a multi-portal VATS group for subgroup analysis. ResultsFinally 131 patients were enrolled, including 62 males and 69 females with an average age of 39.3±13.2 years. There were 103 patients in the VATS group and 28 patients in the thoracotomy group. A total of 104 patients were diagnosed with left lower BPS, 26 with right lower BPS and 1 with bilateral lower BPS. The main symptom was cough (88 patients, 67.2%). There were 119 patients diagnosed by thoracic enhanced CT before operation. Compared with the thoracotomy group, the operation time was not statistically different (P=0.717), but the blood loss was less, the rate of postoperative complication was lower and hospital stay was shorter in the VATS group (P＜0.05). The rate of conversion to open surgery in the uni-portal VATS group and multi-portal VATS group was 11.8% and 13.5%, respectively. Meanwhile, patients in the uni-portal VATS group had shorter operation time and postoperative hospital stay, less blood loss and lower postoperative complication rate than those in the multi-portal VATS group (P＜0.05). Conclusion In order to improve the rate of diagnosis, the lung enhanced CT scan should be selected as an optimal noninvasive method in adult suspected patients (especially those with solid cystic and solid lesions in the lower lobe). Uni-portal VATS is a safe and feasible method for BPS which can be widely promoted.
Objective To study the efficacy of invasive ventilation in critical severe acute respiratory syndrome (SARS). Methods Retrospective analysis was applied to study the efficacy of invasive ventilation and the effect of isolating and protecting measures in 6 critical SARS patients and the effect of isolation measures in ICU from November 2002 to April 2003. Results Six SARS patients were successfully weaned from mechanical ventilation and left hospital. Hypoxemia and oxygenation index（PaO2/FiO2）improved significantly after ventilation (Plt;0.01), peak inspiratory airway pressure (P=0.002), mean airway pressure (P=0.004), and the level of positive expiration end pressure decreased significantly (Plt;0.001). Ventilator-associated pneumonia occurred in 5 patients. Sedatives were used less and the duration of ventilation was shorter when using PRVC compared with SIMV. There was no SARS nosocomial infection among medical staff, other patients and their families. Conclusions Application of invasive ventilation and effective isolation measures could reduce the death rate, shorten the duration of ventilation, and also decrease SARS nosocomial infection.
Abstract: Objective To summarize the clinical experiences and surgical treatment of pulmonary sequestration (PS) in order to improve the diagnosis and treatment of PS. Methods Between August 1993 and February 2007, our department enrolled 21 PS patients, 8 male patients and 13 female patients, with the age ranging from 13 to 70 years old. The patients were examined by chest radiography, computerized tomography (CT), computerized tomography angiography (CTA), magnetic resonance imaging (MRI), position emission tomographyCT(PET-CT) before the surgery. Sequestrectomy was performed on patients with extralobar sequestration (ELS) and lobectomy was performed on patients with intralobar sequestration (ILS). There were 10 cases of left lower lobectomy, 3 cases of right lower lobectomy, 4 cases of left sequestrectomy, 3 cases of right sequestrectomy and 1 case of total pneumonectomy. Results Postoperative pathology confirmed all cases of PS, including 7 cases of ELS and 14 cases of ILS. Seven patients were diagnosed to have PS by preoperative diagnostic procedures. During the surgery, we found aberrant supporting arteries from the general circulation in 18 cases among which 11 were supported by the thoracic aorta, 6 by the abdominal aorta and 1 by both the thoracic and abdominal aorta. The diameter of the aberrant artery was between 0.2 cm and 1.1 cm (mean 0.7 cm). Double ligation and transfixion were performed during the operation. In addition, we found venous drainage through the inferior pulmonary vein in 3 patients and double ligation was performed. No perioperative death or complications occurred. Followup was done till January 2009 on all the patients but one with a followup rate of 95.2% (20/21). The followup time ranged from 12 to 67 months. All patients survived well except that 1 died from liver metastasis 2 years after the operation because of lung cancer. Conclusion PS is rare and its symptoms are nonspecific, which can cause misdiagnosis and missed diagnosis. The diagnosis of PS mainly depends on CT, CTA, MRI and selected arteriography. Once diagnosed, PS should be removed by surgery. During the surgery, aberrant vessels should be separated and treated with double ligation and transfixion. As for those big aberrant vessels, transfixion can be performed after vascular decompression.