肺基底段异常全身动脉供应的定制管理：病例报告和文献综述

摘要(中文译文)

保留肺实质的策略在异常体循环动脉供应肺基底段中的应用日益受到关注。然而，已有保留肺发生肺梗死的报道，选择最佳治疗的明确标准尚未建立。我们报告2例通过详细的术前影像学检查指导个体化治疗的病例——1例患者行右后基底段切除术，另1例患者行异常动脉的血管内栓塞术——两者术后均无并发症。同时结合相关文献进行回顾，重点探讨潜在的选择标准。一名20岁无症状女性因筛查胸片异常被转诊。CT显示一条起源于腹主动脉的异常动脉供应右后基底段（S10），并伴有较大的血管内血栓。肺动脉显示发育不良仅限于A10，其余分支正常，未见肺实质淤血。在切除异常动脉后，行机器人辅助右S10段切除术。术后病程平稳，患者于术后第6天出院。一名27岁女性因无关指征行CT检查时偶然确诊。一条起源于胸降主动脉的异常动脉供应左基底段。肺动脉分支保留，仅S9-10轻微淤血。血管造影未见动静脉瘘证据。由于认为无需行外科肺切除术，遂行异常动脉弹簧圈栓塞术。未发生并发症，患者于术后第3天出院。对于异常体循环动脉供应肺基底段的患者，当肺动脉分支保留且背景肺实质淤血轻微时，应考虑保留肺实质的方法。

Abstract

Parenchyma-preserving strategies for anomalous systemic arterial supply to the basal segment of the lung have gained increasing attention. However, pulmonary infarction of the preserved lung has been reported, and clear criteria for selecting the optimal treatment have yet to be established. We report 2 cases in which detailed preoperative imaging informed tailored management-right posterior basal segmentectomy in 1 patient and endovascular embolization of the aberrant artery in the other-both without postoperative complications. A review of the relevant literature is also provided, with an emphasis on potential selection criteria. A 20-year-old asymptomatic woman was referred after an abnormal screening chest radiograph. CT demonstrated an aberrant artery arising from the abdominal aorta supplying the right posterior basal segment (S10) with a large intravascular thrombus. The pulmonary artery showed hypoplasia limited to A10, while the other branches were normal, and no parenchymal congestion was identified. Following resection of the aberrant artery, robot-assisted right S10 segmentectomy was performed. The postoperative course was uneventful, and the patient was discharged on POD 6. A 27-year-old woman was incidentally diagnosed on CT for an unrelated indication. An aberrant artery arising from the descending thoracic aorta supplied the left basal segment. Pulmonary arterial branches were preserved, with only minimal congestion in S9-10. Angiography revealed no evidence of an arteriovenous fistula. As surgical lung resection was considered unnecessary, coil embolization of the aberrant artery was performed. No complications occurred, and the patient was discharged on day 3 after the procedure. In patients with anomalous systemic arterial supply to the basal segment of the lung, when pulmonary arterial branches are preserved and background parenchymal congestion is minimal, parenchyma-sparing approaches should be considered.

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