肺硬化性血管瘤165例外科治疗

Surgery treatment for pulmonary sclerosing hemangioma

目的 探讨肺硬化性血管瘤的临床特点和诊疗方案.方法 回顾性分析1985年1月至2010年12月病理诊断为肺硬化性血管瘤病例的临床表现、诊断、手术和随访经过.共165例患者,男性27例,女性138例；年龄17～77岁,平均（48±13）岁.肿瘤位于右肺89例（上叶27例、中叶24例、下叶34例、上中叶跨叶裂2例、中下叶跨叶裂1例、上叶和下叶多发1例）,左肺75例（上叶33例、下叶42例）,双肺1例；多发性6例（3.6％）,巨块型2例,支气管腔内型2例.术前误诊为恶性肿瘤48例（29.1％）,术中误诊为恶性肿瘤41例（24.8％）.结果 165例均接受手术治疗,手术方式包括单纯肺叶切除89例,复合肺叶切除5例,肺楔形切除61例,肿瘤摘除6例,肺段切除2例；同期双肺楔形切除1例；胸腔镜手术53例,开胸手术112例.手术并发症2例,无围手术期死亡,术后平均随访34.7个月,无复发,1例死于肺癌.结论 硬化性血管瘤是肺部良性肿瘤,术前术中诊断困难,手术切除是惟一治疗措施,手术入路首选胸腔镜.

Objective To investigate the clinicopathological features and surgical treatment of pulmonary sclerosing hemangioma（PSH）.Methods Clinic data of PSH patients admitted by surgical resection from January 1985 to December 2010 was analyzed retrospectively.One hundred and sixty-five patients were enrolled in the study.There were 27 male and 138 female patients with a mean age of（48 ± 13）years.Seventy-nine patients were asymptomatic at the time of diagnosis.Eighty-nine tumors arose in the right lung（27 in right upper lobe,24 in right middle lobe,34 in right lower lobe,2 in right upper lobe with invasion of right middle lobe,1 in right middle lobe with invasion of right lower lobe,and 1 case with multiple lobe lesions）,75 in the left（33 in left upper lobe,42 in left lower lobe）,and 1 in the bilateral.There were huge mass lesions in 2 cases,endobronchial lesions in 2 cases,and multiple lesions in 6 cases.The mean size of the lesion was（2.6 ± 0.9）cm（ranging from 0.9 to 10.0 cm）.Forty-eight cases （29.1%）were misdiagnosed as malignancies preoperatively,and 41 cases（24.8%）were misdiagnosed intraoperatively.Results Resections were performed by means of video-assisted thoracoscopy（n =53）and thoracotomy（n =112）.Surgical resection included pulmonary wedge excision in 61 patients,lobectomy in 89 patients,right bilobectomy in 5 patients,anatomic segmentectomy in 2 patient,enucleation in 6 patients,and synchronal bilateral pulmonary wedge resection in 1 patient.Operative mortality and morbidity occurred in0 and 2（4.3%）patients,respectively.Mean follow-up was 34.7 months（ranging from 6 to 62months）.There was no local recurrence or death from PSH.Conclusions PSH is a rare benign lung tumor.It is difficult to make accurate diagnosis preoperatively,and sometimes even intraoperative frozen sections can＇t differentiate it from malignant tumors.Surgical resection is usually indicated for definite diagnosis and treatment.Partial resection is a sufficient treatment in view of uncommon tumor recurrence.Thoracoscopic surgery is recommended for PSH.