肺错构瘤的诊断与治疗

Diagnosis and treatment of pulmonary hamartoma

目的总结肺错构瘤的发病特点、影像学特性、治疗方法及预后。方法统计１９７１～１９９８年间胸外科手术治疗并经病理证实为肺错构瘤３９例的症状、病程、影像学特点及手术术式等临床资料，随访３１例观察其预后。结果本组病例的平均发病年龄为４４岁，平均病程１３个月。２１例无症状，体检时偶然发现。１８例有症状者有不同程度的咳嗽、咳痰、发热、胸闷、气短。２１例病灶位于右肺，１８例位于左肺。肺错构瘤病灶边缘多光滑，无卫星灶，影像学特点为“爆米花”样钙化。术式肿物单纯核出３１例，楔形切除４例，肺叶切除３例，全肺切除１例。手术后效果良好，随访３１例无一例复发与恶变。结论肺错构瘤是一种预后良好的肿瘤。管内型错构瘤应与中心型肺癌鉴别。肿瘤核出术是治疗该病的理想手术方法。

Objective To summarize the characteristics of pathogenesis, image, treatment and prognosis of pulmonary hamartoma. Methods 39 cases with hamartoma confirmed by pathology received surgical operation during 19711998 period. Their clinical data including symptoms, disease courses, image characteristics and surgery types were investigated. The prognostic results of 31 cases were collected by a followup study. Results The average age of morbidity was 44 years old and the mean disease course of hamartoma was 13 months. 21 cases without symptoms were determinated by chance and 18 cases with some extent of cough,expectoration, fever, chest distress, and short of breath. The hamartomas of 21 cases were in right lung, 18 in the left. Image characteristics presented as popcornshaped tumor with clear border and without satellite focus. 31 cases underwent enucleation, 4 wedge shaped resection, 3 lobectomy and 1 pneumonectomy. No recurrence or malignant change was demonstrated by followup study. Conclusions Pulmonary hamartoma is a kind of neoplasms with satisfactory prognosis. Intraluminal hamartoma should be differentiated from hilar lung cancer. Localized resection should be performed for the treatment of the disease.