原发性肺透明细胞癌的外科治疗

Surgical therapy of primary lung clear cell carcinoma

目的探讨原发性肺透明细胞癌的临床特征、疗效和预后。方法回顾同济医院1990年至2008年收治的11例原发性肺透明细胞癌临床资料,并复习文献。结果11例患者中9例为男性,年龄39～73岁,平均58岁。其中吸烟者9例,全部为男性,平均吸烟指数大于500支.年。从开始就医到确诊的时间平均4.5个月。临床症状以咳嗽、痰中带血、胸痛等症状为主。胸部X线片表现为密度均匀团块状阴影,边缘欠规则,平均直径大于7cm,最大者达13cm;术前行纤维支气管镜检查者11例,其中3例发现支气管腔内新生物,全部行刷片检查病理报告阳性,其中误诊鳞癌2例,1例考虑为透明细胞癌。11例患者经胸部CT扫描,显示瘤体呈类圆形或椭圆形,密度高而均匀,瘤体未见有空洞,具浅分叶或短毛刺、胸膜凹陷征等恶性肿瘤特征性表现。术后均经病理学检查确诊。结论病理检查是确诊的主要依据。治疗采取以手术为主的综合治疗。

Objective To discuss the clinical features, effect and the prognosis of the primary lung clear cell carcinoma. Methods The data were retrospectively analyzed the clinical materials of the 11 cases of the primary lung clear cell carcinoma were reviewed. Resuits 9 cases were men and 2 cases were women in totaling 11 cases. The age of onset of symptom ranged 39-73-year-old, with an average age of 58-year-old. All 9 male patients smoking, average smoking index ≥500/year. Time of obtaining diagnosis was between 2 weeks and 11 months with an average of 4. 5 months. The main clinical menifestations included cough, hemoptysis and chest pain so on. Chest X plain film illustrated uniform density of the shadow of the massive, the edge of the tumors was not smooth, with an average diameter≥7cm, and the biggest diameter of the tumor 〉 13 cm; All cases had been performed fiber bronchoscopy preoperatively, 3 patients found a neoplasm intra-bmnchial cavity, and brushed pathology report malignant lesions, 2 cases were misdiagnosed as squamous cell carcinoma, 1 case was considered clear cell carcinoma of the lung. All patients with chest CT scans showed that the feature of the tumor including the shape was round or elliptic, the density was uniformal and high, non-cavity, shallow sub-leaf, short glitch and pleural indentation sign so on. Conclusion There are no specific clinical manifestations for the diagnosis of primary lung clear cell carcinoma. Pathology examination is needed for the diagnosing.