肺硬化性血管瘤的诊断和外科治疗(附33例报告)

Diagnosis and surgical treatment of pulmonary sclerosing hemangioma: Report of 33 cases

目的探讨肺硬化性血管瘤诊断和外科治疗。方法回顾性分析我院1987~2002年33例(34个肿瘤)肺硬化性血管瘤的临床资料。男6例,女27例。年龄24~57岁,平均41.3岁。症状以痰中带血23例;无症状10例。影像学均表现为孤立性结节,其中5例有新月征。结果术前28例诊断为肺良性肿瘤,其中5例考虑诊断为肺硬化性血管瘤;1例经皮肺穿刺确诊为肺硬化性血管瘤;4例误诊为肺癌。全组均行手术治疗,其中肺叶切除21例,双肺叶切除1例,肺段切除5例,楔形切除4例(其中1例为经胸腔镜双侧同期切除),肿瘤摘除2例。手术时间45 m in^3.5 h,平均1.5 h,出血量100~600m l,平均230 m l。无围术期死亡。33例随访3~10年,平均5.5年,无一例复发。结论对中年女性,痰中带血,影像学表现为孤立性结节,特别是有新月征者,应考虑本症。经皮肺穿刺病理学检查,可使部分患者确诊。手术治疗效果良好。

Objective To discuss the diagnosis and surgical management of pulmonary sclerosing hemangioma （PSH）. Methods Clinical records of 33 cases of PSH （34 lesions） in this hospital from 1987 to 2002 were reviewed. There were 6 male cases and 27 female cases, with a mean age of 41.3 years （range, 24 -57 years）, Twenty- three cases had an initial symptom of bloody sputum, while 10 cases were disclosed by physical examinations. Image findings revealed solitary mass of the lung in all the cases, in 5 of which a “crescent sign” was presented, Results Preoperatively, 28 cases were diagnosed as having pulmonary benign tumors （including 5 cases of suspected sclerosing hemangioma） , 1 case was clarified as having PSH by percutaneous needle aspiration cytology, and 4 cases were misdiagnosed as having lung cancer. All the patients received surgical treatment, including 21 cases of unilateral pulmonary lobectomy, 1 case of bilateral lobeetomy, 5 cases of segmentectomy, 4 cases of wedge resection （ including 1 case of bilateral thoracoscopic wedge resection） , and 2 cases of tumor excision. The operation time was 45 - 210 min （ mean, 90 min） , and the blood loss was 100 - 600 ml （mean, 230 ml）. No peri - operative deaths were encountered. Follow - up surveys in 33 cases for 3 -10 years （mean, 5. 5 years） found no recurrence. Conclusions In middle - aged women, if the sign of bloody sputum develops, and image findings indicate the solitary mass of the lung, especially with a “crescent sign”, a diagnosis of PSH is possible, Percutaneous needle aspiration cytology is helpful to make a confirmative diagnosis in some patients. It is advisable to manage the disease surgically.