外科治疗直径不大于3cm的细支气管肺泡癌32例

Surgical treatment of bronchioloalveolar carcinoma 3 centimeters or less in diameter-32 cases report

目的探讨直径不大于3 cm的细支气管肺泡癌的临床症状、诊断、影像特点及手术治疗。方法回顾性分析2000年1月至2010年6月我科手术治疗的肿瘤最大直径（CT测量）不大于3cm的周围型细支气管肺泡癌（BAC）。结果共32例,男女各16例。多为查体发现（65.6%）,发病/发现至入院时间10-130 d。20例术前诊断为周围型肺癌,1例误诊为肺炎,11例诊断为肺部病变,无一例术前诊断BAC。手术方式：肺楔形切除术1例,肺叶切除＋纵隔淋巴结清扫/采样31例。病理分期：T1N1M01例,T1NXM01例（肺楔形切除）,T1N0M030例。结论 BAC有独特的临床特点,男女发病比例相当。多为查体发现,首诊时难确诊,多经动态观察才决定手术。肺门及纵隔淋巴结转移少见。确诊需要石蜡病理证实,术中冰冻确诊BAC存在困难。

Objective To investigate the clinical symptom,diagnosis,characteristics of iconography and operation of bronchioloalveolar carcinoma（BAC）of the lung 3 centimeters or less in diameter.Methods Thirty-two cases of peripheral bronchioloalveolar carcinoma（BAC） with the maximal diameter being 3 centimeters or less（measured by CT）,which underwent operation in our department from Jane 2000 to Jun 2010,were analyzed retrospectively.Results There were 16 males and 16 females,most were detected by physical examination（65.6%）,the time from onset of disease/to be detected to hospitalization was 10-130 days.The preoperation diagnoses were peripheral lung cancer in 20 cases,pneumonia in one case,and lesion of lung in 11 cases,none was diagnosed as BAC.The modes of operation were wedge resection in one case,pulmonary lobectomy and lymph node dissection or tissue sampling in 31 cases.The pathologic stages： one was T1N1M0,one was T1NXM0（wedge resection）,30 cases were T1N0M0.Conclusion BAC has particular clinical features.The morbidity is equal between males and females.Most of BAC are detected by physical examination,and undergo a long period of time for dynamic observation before operation.The early diagnosis is difficult.The metastasis to mediastinal and pulmonary hilus lymph nodes is unusual.The correct diagnosis of BAC should depend on paraffin section,while frozen section during operation may make misdiagnosis.