肺炎性假瘤的外科治疗

Surgical Treatment for Inflammatory Pseudotumors of the Lung: With a report of 30 Cases

目的 探讨肺炎性假瘤的临床特征、误诊原因及治疗方法。方法 回顾分析我科在 1989～ 1999年十年间手术治疗的 30例肺炎性假瘤病历并重新观察病理切片。结果 一部分病例与炎症有一定的联系 ,一部分病例具有明确的局部侵犯行为。术前 2 1例 (70 % )误诊为肺癌 ,仅 9例 (30 % )考虑到炎性假瘤且不能排除肺癌。全组均行手术治疗 ,术后除 1例并发支气管胸膜瘘短期治愈外余均顺利恢复。 2 3例随访 6个月～ 5年 ,2例死亡 ,存活的 2 1例病灶无复发。结论 肺炎性假瘤是一大类未能细分的多种病变的总称而并非一种单一的病变 ,其中一部分可能是真性肿瘤。诊断上很难与肺癌和低度恶性纤维肉瘤鉴别。治疗应以及早手术、彻底切除病灶、尽量保存健肺组织为原则。对光镜发现大量梭型细胞浸润的病例应随访。

Aim:To discuss the etiology and surgical treatment of the inflammatory peseudotumors of the lung(IPL).Methods:30 cases of IPL surgically treated from 1989 to 1999 were reviewed.Results:Some cases had the evidence of inflammation while others had marked local invasion. All patients received surgery, including wedge or segmental resection in 11 cases,lobectomy in 15,pneumonectomy in 3 and exploration in 1.Preoperatively, 21(70%) cases were misdiagnosed as lung cancer or tuberculoma,only 9(30%) cases were suspected having IPL while lung cancer could not be excluded.There were no postoperative mortality and complications except one, who suffered from bronchopleural fistula but was cured soon after. half to five years follow up was given to 23 cases.Among them 2 cases died while the others were still alive without recurrence.Conclusion:Most probably,IPL is a ferm which includes diverse group of lesions that neither appear to be etiologically related nor can be subclassified under light microscope.Some of IPL may be real tumor.It is difficult to distinguish IPL from pulmonary adenocarcinoma and low grade sarcoma.Complete surgical resection should be performed as soon as diagnosis was made.Follow up should be given to the cases who have predominant infiltration of spindle cells under light microscope.