肺炎性假瘤43例诊断与手术治疗

Diagnosis and surgical operation for 43 patients with pulmonary inflammatory pseudotumor

目的:探讨肺炎性假瘤(pulmonary inflamnatory pseudotumor,PIP)的诊断和治疗,以期降低误诊率,提高疗效。方法:43例PIP全部手术治疗,肺叶切除术29例,楔形切除11例,全肺切除3例,并经病理证实。结果:术前37例误诊,误诊率86%。误诊为肺癌18例,肺占位性病变13例,肺结核5例,其他1例。术后脓胸1例,无其他并发症,无死亡病例,均痊愈出院。结论:PIP属良性病变,其临床表现和影像学检查缺乏特征性变化,术前误诊率高。手术方式以局限性肺切除或肺叶切除为主。术前肿块穿刺活检和术中冷冻病理切片是诊断和决定术式的主要依据。

Objective：To investigate the diagnosis and surgical management of pulmonary inflammatory pseudotumor （PIP） to reduce the rate of misdiagnosis and enhance the curative effect. Methods： Forty-three patients with PIP underwent the operation including lobectomy in 29 patients, wedge excision in 11, total pneumonteony in 3, All patients were identified by pathological examination, Results：Thirty-seven patients were misdiagnosed before operation with the rate of misdiagnosis at 86%, Eighteen patients were misdiagnosed as lung cancer, 13 as occupied lesion in the lung,5 as the pulmonary tuberculosis, 1 as other. The thoracic empyema occurred in one patient, There were no other complications and death, All patients convalesced. Conclusions：PIP is a benign lesion. It lacks the characteristic of clinical presentations and imaging symptoms. The rate of misdiagnosis is high before operation so that it is necessary to improve the knowledge of PIP to reduce it. The main patterns of surgical management are lobectomy and tumor excision. The diagnosis and surgical pattern depend on the preoperative biopsy and the intraoperative frozen pathological section.