Clinical Presentation, Radiological Features, and Surgical Treatment of Bronchogenic Cysts

支氣管性囊腫的臨床表現、影像特徵與手術治療之探討

蔡岳峰(Yueh-Feng Tsai) ； 吳明和(Ming-Ho Wu) ； 賴吾為(Wu-Wei Lai) ； 曾堯麟(Yau-Lin Tseng) ； 林木源(Mu-Yen Lin) ； 張家銘(Jia-Ming Chang)

《胸腔醫學》 18卷3期 (2003/06) Pp. 214-221

https://doi.org/10.29806/TM.200306.0004

摘要

目的：探討肺內與縱隔腔不同位置的支氣管性囊腫，其臨床表現及影像特徵之差異。
材料及方法：從1989至2002年，15位支氣管性囊腫病患在本院接受手術治療。藉由回顧病歷記載、影像照片及門診追蹤來進行研究。
結果：有9位男性及6位女性病患，年齡分布從3個月到76歲，平均36.3歲。7位（47%）是肺內支氣管性囊腫，8位（53%）是縱隔腔支氣管性囊腫；15位病患中，11位（73%）有臨床症狀；7個肺內支氣管性囊腫患者中，6位（86%）有症狀，8個縱隔腔支氣管性囊腫患者中，5位（63%）有症狀（p=0.000）。13個（87%）囊腫可由胸部X光判讀出來，剩餘的2個縱隔腔支氣管性囊腫則無法從X光片看出。所有病灶均能藉電腦斷層掃描偵測到。4個（57%）肺內支氣管性囊腫在X光影像上顯現含有氣體成份，另外3個以固體腫塊表現。縱隔腔支氣管性囊腫則均呈現為固體腫塊而無氣體組成（p=0.000），另外，有4位患者接受食道攝影，或併用內視鏡檢查，以排除食道上皮性病灶。肺內支氣管性囊腫的手術方式包括肺楔狀切除（n=4）、肺葉切除（n=2）、及肺節切除（n=1）。縱隔腔囊腫的切除則利用電視輔助胸腔手術（n=4）、胸廓切開術（n=3）、或縱隔腔鏡（n=1）來完成。追蹤期從1周到1年，平均3.8個月。無手術致死病例。所有病患均能治癒。但一患者還有一顆小的、沒有症狀的、位於主病灶旁的縱隔腔囊腫需要進一步觀察。
結論：肺內支氣管性囊腫與縱隔腔囊腫比較起來有較高的比例會產生症狀。在放射線影像上，肺內病灶往往呈現為含氣囊腫，而縱隔腔病灶則表現出界線明確的腫塊。對罹患支氣管性囊腫的病患而言，手術切除是達到治癒的可靠方法。

關鍵字

支氣管性囊腫 ； 肺囊腫 ； 縱隔腔囊腫

並列摘要

Objective: To study the differences in the clinical presentation and radiological features of intrapulmonary and mediastinal bronchogenic cysts.
Materials and Methods: From 1989 to 2002, 15 patients with bronchogenic cysts underwent surgery at our hospital. Their medical records and radiographs were reviewed. Follow-up studies were obtained in the outpatient department.
Results: The patients included 9 males and 6 females whose ages ranged from 3 months to 76 years, with a mean age of 36.3 years. The lesions were intrapulmonary in 7 (47%) patients and mediastinal in 8 (53%). Eleven (73%) of the 15 bronchogenic cysts had symptoms: 6 (86%) of the 7 intrapulmonary bronchogenic cysts and 5 (63%) of the 8 mediastinal bronchogenic cysts (p=0.000). Thirteen (87%) cysts were initially discovered by chest radiography. The 2 undetected cysts were located in the mediastinum. All lesions were detectable on computed tomographic scans. Of the intrapulmonary bronchogenic cysts, 4 (57%) appeared air-containing on radiographs, and 3 presented as solid masses. All detected mediastinal cysts appeared as solid masses without air content (p=0.000). Four patients underwent esophagography, alone or combined with endoscopy, to exclude epithelial lesions of the esophagus. Intrapulmonary cysts were treated with pulmonary wedge resection (n=4), lobectomy (n=2), or segmentectomy (n=1). Excision of the mediastinal cysts was completed by video-assisted thoracic surgery (n=4), posterolateral thoracotomy (n=3), or mediastinoscopy (n=1). The follow-up period ranged from 1 week to 1 year, with a mean of 3.8 months. No surgical mortality occurred. All patients were cured, but one patient with a small, occult satellite mediastinal cyst required further observation.
Conclusions: A large proportion of intrapulmonary bronchogenic cysts cause more symptoms than mediastinal cysts. Radiological features reveal a higher incidence of air-content in intrapulmonary bronchogenic cysts, compared with mediastinal cysts which present as solid masses. Surgical excision is a reliable treatment to achieve cure for those patients with bronchogenic cysts.

並列關鍵字

bronchogenic cyst ； lung cyst ； mediastinal cyst