肺硬化性血管瘤的诊治

Diagnosis and Treatment for Pulmonary Sclerosing Hemangioma

背景与目的肺硬化性血管瘤(pulmonary sclerosing hemangioma,PSH)概念的提出迄今只有50余年,是一种少见的肺部良性疾病。PSH临床表现有一定特点,需与肺癌鉴别诊断。本文总结我院48例PSH的临床诊治经验并复习文献,旨在提高对PSH的认识,探讨合理的诊断与治疗手段。方法 2001年1月-2011年4月共收治PSH48例,结合文献报道总结分析PSH的发病特点、临床表现、影像学、病理学特点及预后。结果全组48例,无症状者27例(56.3%),肿物大小0.2cm-7.0cm,平均2.1cm,各个肺叶均有发生。合并肺门或纵隔淋巴结肿大者15例(31.3%)。手术47例,其中肺叶部分切除29例(61.7%),肺叶切除14例(29.8%),肿物剔除3例(6.4%),前纵隔肿物切除者1例(2.1%)。47例术后均无复发。CT引导下穿刺活检诊断1例,随访28个月未见肿瘤进展。结论 PSH术前定性诊断困难,手术既是确诊手段又是有效的治疗手段,该病预后良好。

Background and objective The concept of pulmonary sclerosing hemangioma（PSH） was proposed only 50 years ago.PSH features several characteristics that should be differently diagnosed with lung cancer.The aim of this study is to retrospectively review the diagnosis and treatment of 48 cases of PSH,review recent publications about this topic,and address reasonable diagnosis and treatment methods.Methods Forty-eight patients with PSH were enrolled and con-secutively treated from January 2001 to April 2011.Clinical presentations,image characteristics,pathologic morphologies,and prognostic data were analyzed.Results Twenty-seven PSH cases（56.3%） were asymptomatic.Tumor diameters ranged from 0.2 to 7.0 cm,with an average diameter of 2.1 cm,and involved both lobes of the lungs.Enlarged lymph nodes in the mediastinum were detected via computed tomography（CT） scans in 15 cases（31.3%）.Only 47 patients underwent surgery.Pulmonary wedge resection was performed in 29 cases（61.7%） while lobectomy was performed in 14（29.8%）.The tumor was removed in 3 cases（6.4%） and anterior mediastinal tumor resection was performed in 1 case（2.1%）.Forty-seven patients reported no recurrence during follow-up while one patient refused surgery after a CT-guided biopsy with no progression dur-ing the 28-month follow up period.Conclusion The exact diagnosis of PSH is difficult prior to surgery.Surgery is an effective method of treatment that allows both definite diagnosis and accurate therapy.The prognosis of PSH is favorable.