肺内良性球形病变43例误诊分析

Misdiagnosis of benign spherical masses in lung: analysis of 43 cases

目的提出几种肺内良性球形病变的鉴别诊断方法。方法对 43例经术后病理证实的肺内良性球形病变的误诊情况进行分析。结果肺内良性球形病变以肺结核球、炎性假瘤、硬化性血管瘤、曲菌病、错构瘤及肺隔离症多见 ,术前均误诊为其他病变 ,误诊率 3 9 8%。结论肺内良性球形病变应依据临床表现与病程、病变部位与影像学进行鉴别诊断 ,必要时行纤维支气管镜、肺穿刺活检 ,对术前仍不能确诊的肺内孤立性病灶应积极手术治疗 ,术中一定要做快速冷冻病理活检 ,以便根据其性质确定肺切除的范围 。

Objective To propose the methods of differential diagnosis between several benign spherical masses in lung. Methods We analyzed 43 cases of benign spherical masses in lung,which were confirmed with postoperative pathology. Results Benign spherical masses in lung mainly included the followings:pulmonary tuberculoma,nnflammatory pseudotumor,sclerosing hemangioma,aspergillosis,hamartoma and pulmonary sequestration.All the 43 cases were misdiagnosed preoperatively with a misdiagnosis rate of 39.8%. Conclusions Differential diagnosis should be carried out on the basis of clinical manifestations,courses of the disease,location and imaging examination results.When necessary,fiberbronchoscopy and biopsy of lung should be performed.When a diagnosis could be reached preoperatively,surgical management was encouraged.During the operation,speed pathological examination on frozen section was necessitated in order to know the property of masses and to decide an optimal margin of surgery and to retain the function of lung as much as possible.