■先天性肺隔离症是一种罕见的肺异常,可分为叶内肺隔离症或叶外肺隔离症(ELS)。膈肌性肺隔离症是一种罕见的ELS。此外,胸内肾(ITK)是一种罕见的疾病,在0.25%的病例中可能与先天性膈疝(CHD)相关。我们报告了第一例与儿童CDH相关的the肌隔离症和ITK。
■病人,男性,6个月大,2个月前因呼吸急促到我们医院就诊.基于胸部超声和增强计算机断层扫描(CT)检查,膈肌隔离症和ITK被认为与CDH相关.患者入院治疗。入院后,他的血压是85/61mmHg,没有血尿或蛋白尿,肌酐为14μmol/L,尿素氮为2.96mmol/L,所有这些都没有异常。在手术治疗之前进行了完整的术前检查。胸腔镜检查显示,右肾在隔膜的后外侧突出到胸腔中。右肾回到腹腔,疝囊被打开了,观察到明亮的红色病变组织,边界清晰,血管供应异常。切断异常血管后,LigaSureTM用于切除病变组织,可见肾脂肪囊和肾组织。对疝环进行间歇性缝合以密封膈疝。术后病理检查提示膈肌隔离症。患者术后恢复顺利,2个月时胸部CT扫描显示右肾已回到腹腔,右膈肌位置正常。
■与CDH相关的膈肌隔离症和ITK极为罕见。可以使用增强的CT来制定诊断和适当的手术计划。对于位于CHD疝囊顶部的膈肌隔离症,胸腔镜下切除膈肌隔离症和修补术治疗膈肌疝是可行和有效的。
UNASSIGNED: Congenital pulmonary sequestration is a rare lung anomaly that can be classified as intralobar pulmonary sequestration or extralobar lung sequestration (ELS). Infradiaphragmatic pulmonary sequestration is a rare type of ELS. Furthermore, intrathoracic kidney (ITK) is a rare disease that can be associated with a congenital diaphragmatic hernia (CHD) in 0.25% of cases. We report the first case of infradiaphragmatic pulmonary sequestration and ITK associated with CDH in a child.
UNASSIGNED: The patient, male, aged 6 months, visited our hospital 2 months prior due to shortness of breath. Based on chest ultrasonography and enhanced computed tomography (CT) examination, infradiaphragmatic pulmonary sequestration and ITK were considered to be associated with CDH. The patient was admitted to our hospital for treatment. After admission, his blood pressure was 85/61 mmHg, there was no hematuria or proteinuria, creatinine was 14 µmol/L, and urea nitrogen was 2.96 mmol/L, all of which showed no abnormalities. A complete preoperative examination was performed prior to surgical treatment. Thoracoscopy revealed that the right kidney had herniated into the chest cavity on the posterolateral side of the diaphragm. The right kidney was returned to the abdominal cavity, the hernia sac was opened, and a bright red lesion tissue with clear boundaries and an abnormal blood vessel supply was observed. After cutting off the abnormal blood vessels, LigaSure TM was used to remove the diseased tissue, and the renal fat sacs and renal tissue were visible. Intermittent suturing of the hernia ring was performed to seal the diaphragmatic hernia. Postoperative pathological examination revealed infradiaphragmatic pulmonary sequestration. The postoperative recovery of the patient was smooth, and a chest CT scan at 2 months showed that the right kidney had returned to the abdominal cavity and the right diaphragm was in the normal position.
UNASSIGNED: Infradiaphragmatic pulmonary sequestration and ITK associated with CDH is extremely rare. A diagnosis and appropriate surgical planning can be developed using enhanced CT. For infradiaphragmatic pulmonary sequestration located at the top of the hernia sac in CHD, thoracoscopic resection of the infradiaphragmatic pulmonary sequestration and repair of the diaphragmatic hernia is feasible and effective.