孤立性肺结节100例临床分析

Solitary pulmonary nodules:a report of 100 cases

目的探讨孤立性肺结节(SPN)的诊断与治疗。方法经手术切除明确病理诊断的孤立性肺结节(SPN)患者100例,分析患者的临床特征、病理变化和影像学资料;对SPN与临床病理因素的相关性进行分析。结果肿瘤剔除术10例,楔形切除28例(其中5例患者高龄,心肺功能较差,行肺段切除术),肺叶切除61例(包括1例左全肺切除),1例开胸探查。术后病理良性病变30例,其中结核瘤13例,炎性假瘤9例,硬化性血管瘤4例,霉菌性肺炎1例,间质性肺炎1例,肺囊肿1例,动静脉瘘1例;恶性病变70例,其中腺癌38例,鳞癌19例,肺泡细胞癌9例,类癌2例,小细胞癌2例。良恶性病变患者在年龄、肿瘤最大径、边界、影像学分叶、胸膜牵拉及胸膜皱缩方面差异有统计学意义,而在性别、吸烟史、临床症状方面无统计学差异。结论病人年龄、肿瘤最大径、边界、影像学分叶、胸膜牵拉及胸膜皱缩对判断SPN的良恶性有重要意义,电视胸腔镜(VATS)手术可以作为诊断和治疗典型SPN的首要选择。

Objective To investigate the diagnosis and treatment of the solitary pulmonary nodules（SPN）. Methods The clinical features and imagings of 100 cases of SPN were retrospectively analyzed.The correlation of malignant lesions with clinicopathological features was analyzed in SPN patients. Results Tumor resection was performed in 10 cases,wedge resection in 28 cases（5 aged patients with poor cardiac and pulmonary function underwent pulmonary segmentectomy）,lobectomy in 61 cases（including one case of left pneumonectomy）,and thoracic exploration was performed in one case.Benign lesions were diagnosed by postoperative pathology in 30 cases,including 13 cases of tuberculoma,9 cases of inflammatory pseudotumor,4 cases of sclerosing hemangioma,one case of fungal pneumonia,one case of interstitial pneumonia,one case of pulmonary cyst,one case of arteriovenous fistula.Malignant lesions were diagnosed postoperatively in 70 cases,including 38 cases of adenocarcinoma,19 cases of squamous cell carcinoma,9 cases of alveolar cell carcinoma,2 cases of carcinoid,and 2 cases of small cell carcinoma.The malignant lesions were related to patient age,tumor diameter,boundary,lobulation sign,and pleural retraction,but not to sex,smoking history,clinical symptoms. Conclusion Patient age,tumor diameter,boundary,lobulation sign and pleural retraction are important to diagnose the benign and malignance of SPN.VATS operation can be used as the first choice in the diagnosis and treatment of typical SPN.