周围型肺癌的支气管血管集束征——CT病理表现及其形成机制

Bronchovascular convergence sign in peripheral lung cancer ——CT－pathological features and mechanism

目的：分析周围型肺癌的支气管血管集束征CT表现，并结合病理改变探讨其形成机制和判断预后的价值。材料和方法：回顾性分析经手术和病理证实的170例周围型肺癌支气管血管集束征的CT表现和病理基础。依据数目和程度将支气管血管集束征的CT表现分为0～Ⅲ度，并对该征象在肺癌瘤体上的方位进行计数分析。结合各度支气管血管集束征与肺癌的大小、手术病理分期、病理改变的关系分析此征的形成机制和判断预后的价值。结果：①小于或等于10mm周围型小肺癌的绝大多数支气管血管集束征为0度。11mm以上周围型肺癌支气管血管集束征的程度加重，但是11～20mm和21mm以上组两组肺癌之间无明显差别。②随着肺癌病理分期的提高，重度支气管血管集束征的比例亦升高。③支气管血管集束征在肺癌瘤体的4个象限上均可出现，支气管气相以肺门区和外围区为多。结论：①肺癌瘤体内纤维化灶和肿瘤增殖破坏致使肺结构的塌陷皱缩是形成支气管血管集束征的基本原因。②血管集束征并非肺癌的供血血管和肿瘤血管。③支气管血管集束征的程度间接预示肺癌的恶性程度和预后。

Objective:To analyze the CT features of bronchovascular convergence sign in peripheral lung cancer,then to make a scientific approach to its mechanism and value in estimating prognosis of peripheral lung cancer.Materials and Methods:The CT features and pathological basis of bronchovascular convergence sign in 170 peripheral lung cancers proved by operation and pathology were analyzed retrospectively.According to number and grade the sign were divided into 0～Ⅲdegree.The location of bronchovascular convergence sign in tumor were analyzed also.The relation between grade of bronchovascular convergence sign and size，stage，pathological changes of cancers were used to deduce mechanism of this sign,and to estimate prognosis of patients with lung cancer.Results:①The vast majority of ≤10mm small peripheral lung cancer had 0 dgree bronchovascular convergence sign,>11mm peripheral lung cancer had more advanced bronchovascular convergence sign.No marked differences between 11～20mm and >21mm peripheral lung cancer.②Higher staged lung cancer had more advanced bronchovascular convergence sign.③Bronchovascular convergence sign could occur any quarter of tumor,air－bronchogram more often in hilum quarter and peripheral quarter.Conclusion:①Fibrosis and proliferation within peripheral lung cancer are fundamental cause formatting bronchovascular convergence sign.②Vascular convergence sign is not supply vessel and tumor vessel.③Bronchovascular convergence sign can be used to predict prognosis and malignance of peripheral lung cancer indirectly.