肺错构瘤的诊断和手术治疗(附140例报告)

Diagnosis and Surgical Treatment of Pulmonary Hamartoma:A Report of 140 Cases

目的探讨分析肺错构瘤的诊治经验。方法对2006年1月至2010年12月手术治疗的140例肺错构瘤患者的临床特点、术前诊断方法、手术治疗方法等进行回顾性总结。结果本组140例肺错构瘤患者中,男60例,女80例,男女比例为3:4。患者年龄为27～77岁,中位年龄为53岁,好发年龄段为41～60岁(69.3%,97/140)。中心支气管内型肺错构瘤3例,占2.14%(3/140)。大多数患者无任何症状(80.7%),少数患者因出现咳嗽、痰血、气短等非特异性症状就诊发现(19.3%)。本院胸片、CT和术前诊断肺错构瘤的准确率分别为2.7%、46.7%、42.1%。手术切除方式包括肿瘤剥除66例、肺楔形切除66例、肺叶切除7例、全肺切除1例。全组患者无围手术期死亡发生。2例患者术后发生并发症,1例切口感染、1例Ⅱ型呼吸衰竭,均治愈出院。结论肺错构瘤好发于中老年人群,多无症状或无特异性症状,胸部影像学检查偶然发现。影像学上需要与原发肺癌和肺转移瘤鉴别,尽管肺错构瘤可以出现特征性的影像学表现,大部分患者术前难以获得明确诊断。手术方式以完整切除肿瘤同时尽可能保留肺组织为原则。

Objective To investigate and analysis the diagnosis and treatment experiences of pulmonary hamartomas （PH）. Methods From January 2006 to December 2010, 140 patients with PH underwent surgical treatment. The clinical data of these patients including symptoms, disease courses, image characteristics and surgical procedures were reviewed retrospectively. Results The PHs were most frequently （69.3%） found in the patients aged 41 to 60 years with a median age of 53 years （range： 27 -77）, and the sex ratio （male/female） was 3/4 （60/80） in this series. There were only three cases with endobronchial PHs （2.14%）. Of the 140 patients, 113 （80.7%） were asymptomatic, and only 27 （ 19.3% ） had non-special symptoms such as cough, hemoptysis or dyspnea. The accuracy of chest X-ray and CT scan were only 2.7% and 46.7%, respectively, and only 42.1% were assumed as PH preoperatively. One hundred and thirty-two patients underwent limited pulmonary resection （wedge resection 66, enucleation 66 ）, 7 had lobectomy, and 1 pneumonectomy along with synchronous central lung cancer. Conclusions The PHs frequently occur in the middle-aged population. Most patients with PH are asymptomatic or have non-specific symptoms, and are usually found accidentally by chest imaging. It is often difficult to differentiate PH from primary lung cancer or pulmonary metastasis. Although some patients＇ PHs can be diagnosed based on specific image appearances, most of them are willing to receive surgical resection due to their heavy psychological burden or the difficulty to exclude the possibility of malignancy. PHs should be resected completely, and normal pulmonary tissue must be reserved whenever possible.