Matériels et méthodes
RESUME Titre : l’emphysème lobaire géant (à propos de 10 cas)
Mots clé : Malformation pulmonaire – emphysème congénital – Détresse respiratoire –
Lobectomie.
Auteur : Lamiae El Haddad Introduction :
L’ELG est une malformation broncho-pulmonaire congénitale rare se caractérisant par une distension emphysémateuse isolée et systématisée d’un territoire pulmonaire qui peut être lobaire ou segmentaire et dont la présentation clinique varie d’une dyspnée modérée, infections récurrentes à une détresse respiratoires aigue nécessitant une prise en charge en urgence. Son diagnostic est essentiellement radio-clinique et la lobectomie reste le traitement de choix. Actuellement, le diagnostic anténatal est possible mais reste très difficile.
Matériels et méthodes :
Notre travail est une étude rétrospective réalisée au service de chirurgie viscérale pédiatrique (chA) de l’hôpital d’enfant de Rabat étalée sur une période comprise entre mai 2004 et juin 2016.Il recouvre 10 patients hospitalisés pour ELG.
Résultats :
Sur le plan épidémiologique, l’âge de nos patients est compris entre 2 et 15 mois avec un âge moyen de 6 mois. On a noté une prédominance masculine avec un sexe ratio de 2,3.
Les patients étaient tous symptomatiques et la symptomatologie variait d’une dyspnée modérée à une détresse respiratoire aigue.
La radiographie thoracique et la TDM thoracique ont été réalisés chez les patients permettant de poser le diagnostic positif en mettant en évidence une hyperclarté parenchymateuse. La prédominance du lobe supérieur gauche était respectée dans notre étude. Tous les patients ont été traités par lobectomie. L’examen anatomopathologique a confirmé le diagnostic chez tous les cas.
Summary Title: Giant congenital lobar emphysema (about 10 cases)
Key-words: Pulmonary malformation – congenital emphysema – respiratory distress –
lobectomy.
Author: Lamiae El Haddad Introduction:
CLE is a rare congenital broncho-pulmonary malformation characterized by a secluded and systematized emphysematous distension of a pulmonary territory that can be lobar or segmentary and whose clinical presentation ranges from moderate dyspnea, recurring infections to acute respiratory distress requiring urgent care.
Its diagnosis is primarily clinical and radiological, and lobectomy remains the treatment of choice.
Currently, prenatal diagnosis is possible but very difficult nonetheless.
Material and methods:
Our work is a retrospective review carried out in the department of pediatric visceral surgery (Ch A) at the hospital of child in Rabat, spread out over a period spanning between May 2004 and June 2016. It includes 10 patients hospitalized for giant lobar emphysema.
Results:
On the epidemiological level, the average age of our patients is 6 months with extremes of age of 2 and 15 months. A male prevalence was noted with a sex ratio of 2,3.
All patients were symptomatic and symptoms ranged from mild dyspnea to acute respiratory distress.
Chest radiography and chest CT scan were carried out among all patients making it possible to pose the positive diagnosis by highlighting parenchymal lucency.
The prevalence of the left upper lobe was respected in our study. All patients were treated by lobectomy.
Anatomopathological examination confirmed the diagnosis of giant lobar emphysema in all patients.
The evolution was favorable in 8 cases, one patient was deceased and one kept a long-term treatment for cellular bronchiolitis.
ﺺﺨﻠﻣ .(تﻻﺎﺣ 10 دﺪﺼﺑ) قﻼﻤﻌﻟا ﻲﺼﻔﻟا خﺎﻔﻨﻟا :ناﻮﻨﻌﻟا ﺔﯿﺳﺎﺳﻻا تﺎﻤﻠﻜﻟا : يﻮﺋر هﻮﺸﺗ -ﻲﻘﻠﺨﻟا خﺎﻔﻨﻟا ﺔﯿﺴﻔﻨﺗ ﺔﻘﺋﺎﺿ – ﺺﻔﻟا لﺎﺼﺌﺘﺳا . .داﺪﺤﻟا ءﺎﯿﻤﻟ : فﺮط ﻦﻣ ﺔﻣﺪﻘﻤﻟا : ﺤﻟ ﻢﻈﺘ ﻨﻣ لﺰ ﻌﻨﻣ ﺪ ﺘﻤﻣ خﺎ ﻔﺘﻧﺎﺑ ﺰ ﯿﻤﺘﯾ و اردﺎ ﻧ ﺎ ﯿﻘﻠﺧ ﺎ ﯾﻮﺋر ﺎھﻮ ﺸﺗ قﻼ ﻤﻌﻟا ﻲ ﺼﻔﻟا خﺎ ﻔﻨﻟا ﺮ ﺒﺘﻌﯾ ﺰ ﯿ ﺔﯿ ﺴﻔﻨﺗ تﺎ ﺑﺎﮭﺘﻟا ,ﺲﻔﻨ ﺘﻟا ﻲ ﻓ ﺔ ﻔﯿﻔﺧ ﺔﺑﻮﻌ ﺼﺑ ﺎﯾﺮﯾﺮ ﺳ ﻞﺜﻤﺘﯾ و ,ﺎﯿﻌﻄﻗ وا ﺎﯿﺼﻓ نﻮﻜﯾ نا ﻦﻜﻤﯾ ﺚﯿﺤﺑ يﻮﺋر يﺮﯾﺮﺳ ﺎﺳﺎﺳا ﮫﺼﯿﺨﺸﺗ .ﺔﻠﺠﻌﺘﺴﻣ ﺔﯾﺎﻋر مﺰﻠﺘﺴﯾ دﺎﺣ ﻲﺴﻔﻨﺗ ﻖﯿﺿ وا ةرﺮﻜﺘﻣ ﺺﻔﻟا لﺎﺼﺌﺘﺳا و ﻲﻋﺎﻌﺷا ﺎﺒﻌﺻ ﻰﻘﺒﯾ ﮫﻨﻜﻟ ﺎﯿﻟﺎﺣ ﻦﻜﻤﻣ ةدﻻﻮﻟا ﻞﺒﻗ ﮫﻓﺎﺸﺘﻛا .ﻞﻀﻓﻻا جﻼﻌﻟا ﻰﻘﺒﯾ بﺎﺼﻤﻟا .اﺪﺟ داﻮﻣ و ﻞﺋﺎﺳو : لﺎ ﻔطﻻا ﻰﻔ ﺸﺘﺴﻤﺑ لﺎ ﻔطﻸﻟ ءﺎ ﺸﺣﻻا ﺔ ﺣاﺮﺟ ﺔﺤﻠ ﺼﻣ ﻲ ﻓ ةاﺮ ﺠﻣ ﺔﯿﻋﺎﺟﺮﺘ ﺳا ﺔ ﺳارد ﻮ ھ اﺬھ ﺎﻨﻠﻤﻋ يﺎﻣ ﻦﯿﺑ ةﺪﺘﻤﻣ ةﺮﺘﻓ ﻰﻠﻋ طﺎﺑﺮﻟﺎﺑ 2004 ﻮﯿﻧﻮﯾ و 2016 ﻦﻤﻀﺘﺗ و 10 .قﻼﻤﻌﻟا ﻲﺼﻔﻟا خﺎﻔﻨﻠﻟ تﻻﺎﺣ ﺞﺋﺎﺘﻨﻟا : ﻦﯿ ﺑ ﺺﯿﺨ ﺸﺘﻟا ﺪ ﻨﻋ ﺎﻧﺎﺿﺮﻣ رﺎﻤﻋا ﺮﺼﺤﻨﺗ ,ﻲﺋﺎﺑﻮﻟا ىﻮﺘﺴﻤﻟا ﻰﻠﻋ و ﻦﯾﺮﮭ ﺷ 15 لﺪ ﻌﻤﺑ يا اﺮﮭ ﺷ ﻦﺳ 6 ﺔﺒﺴﻨﺑ رﻮﻛﺬﻠﻟ ﺔﯿﺒﻟﺎﻏ ﻊﻣ ﺮﮭﺷا 2,3 . .دﺎﺣ ﻖﯿﻀﺑ و ﺔﻔﯿﻔﺧ ﺔﯿﺴﻔﻨﺗ ﺔﺑﻮﻌﺻ ﻦﯿﺑ ﺖﺣواﺮﺗ ضاﺮﻋﺄﺑ اﻮﻧﺎﻛ ﻰﺿﺮﻤﻟا ﻞﻛ ﺢﻤ ﺳ ﺎ ﻤﻣ ﻰ ﺿﺮﻤﻟا ﻊ ﯿﻤﺠﻟ ﺔﯿﻓاﺮﻏﻮﻧﺎﻜ ﺳ ﺔﯾرﺪﺻ ﺔﯿﻌﻄﻘﻣ رﻮﺻ و ﺔﻌﺷﻷﺎﺑ ﺔﯾرﺪﺻ رﻮﺻ ءاﺮﺟا ﻢﺗ .ﺔﻐﻟﺎﺒﻣ ﺔﯿﻓﺎﻔﺷ رﺎﮭظﺈﺑ ﻚﻟذ و ﺺﯿﺨﺸﺘﻟﺎﺑ ﻠﻏ ﺖﻈﺣﻮﻟ ﺪﻘﻟ .يﻮﻠﻌﻟا ﺮﺴﯾﻻا ﺺﻔﻟا ﺔﺒ .بﺎﺼﻤﻟا ﺺﻔﻠﻟ ﻲﺣاﺮﺟ لﺎﺼﺌﺘﺳﻻ ﻰﺿﺮﻤﻟا ﻊﯿﻤﺟ ﻊﻀﺧ .تﻻﺎﺤﻟا ﻊﯿﻤﺟ ﺪﻨﻋ قﻼﻤﻌﻟا ﻲﺼﻔﻟا خﺎﻔﻨﻟا ﺺﯿﺨﺸﺗ ﺪﻛا ﻲﺿﺮﻤﻟا ﺢﯾﺮﺸﺘﻟا ﻲ ﻓ ﺎ ﯿﺑﺎﺠﯾا نﺎ ﻛ رﻮ ﻄﺘﻟا 8 بﺎ ﮭﺘﻟا جﻼ ﻋ ﺐﺟﻮﺘ ﺳا و ةﺪ ﺣاو ةﺎ ﻓو ﺔ ﻟﺎﺣ ﺪ ﺻر ﻢ ﺗ ﻦﯿ ﺣ ﻲ ﻓ تﻻﺎ ﺣ .ﺮﺧا ﺾﯾﺮﻣ ىﺪﻟ ﻞﯾﻮﻄﻟا ىﺪﻤﻟا ﻰﻠﻋ تﺎﺒﯿﺼﻘﻟا
ANNEXE I
FICHE D’EXPLOITATION I. IDENTITE : NE :………. Nom :……… Age :………. Sexe : M □ F □ Fratrie :………. Ville de résidence :………. Date d’entrée :………. Date de sortie :………. II. ANTECEDENTS : Personnel : □Oui □Non Si oui :……….Grossesse Suivie : □Oui □Non
A terme : □Oui □Non
Grossesse Suivie : □Oui □Non
Mode d’accouchement : □VB □VH
Accouchement en milieu hospitalier: □Oui □Non
Dépistage prénatal : □Oui □Non
Etat de l’enfant à la naissance : Cri immédiat : □Oui □Non
Antécédents Familiaux : □Oui □Non
Si oui :……….
Age d’apparition des symptômes : III- SIGNES CLINIQUE : □Oui □Non
• Dyspnée □
• Toux sèche □
•Cyanose □
•Signes de lutte □
• Détresse respiratoire aigue □
• Tympanisme □ • MV □ • Râles □ • BDC déviés □ • Fièvre □ IV. PARACLINIQUE : 1. Radiographie thoracique : Faite Non faite •Résultats : ………..
2. Tomodensitométrie (TDM) : Faite Non faite
• Résultats :………..
3. Echographie: Faite Non faite Si faite, résultats :………..
4. Autres : Faite Non faite Si faite :………
V. TRAITEMENT :
Chirurgie: □En urgence □Programmée
• Geste réalisé :………..
• Voies d’abord :………..
Suites post-opératoires :
• Durée du séjour en réanimation :………..
• Date d’extubation :……….. Compliquées : VI. HISTOLOGIE :……….. VII. EVOLUTION : • Immédiate :……….. • A long terme :………..
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