成年人肺炎性肌纤维母细胞瘤15例诊治体会

Analysis of clinical diagnosis and treatment in adult patients with pulmonary inflammatorymyofibroblas-tic tumor

目的：探讨成年人肺炎性肌纤维母细胞瘤的临床特点及外科治疗。方法回顾性分析2010年4月至2015年6月我们收治的15例经病理证实为肺炎性肌纤维母细胞瘤患者的临床资料，总结其临床特点及治疗方式、预后。结果15例患者男10例，女5例；年龄39-68岁，中位年龄52岁；1例为复发，14例初治。主要症状：体检发现，咳嗽、痰中带血，胸痛、胸闷，发热。胸部CT：肿物呈圆形或类圆形，分叶状，部分边缘呈毛刺状。免疫组化：波形蛋白阳性、平滑肌肌动蛋白阳性。15例患者分别行开胸或胸腔镜手术局部切除、肺叶切除及肺叶切除＋淋巴结清扫。无围术期死亡，无术后出血、支气管胸膜瘘等并发症。平均随访时间8-58个月，随访率100．0％（15／15），无肿瘤复发。结论肺炎性肌纤维母细胞瘤临床表现较为复杂，明确诊断需依据病理，主要治疗为手术切除，预后良好，复发率低。

Objective To discuss clinical characteristics and surgical treatment of patients with pulmo-nary inflammatory myofibroblastic tumor（PIMT）. Methods From April 2010 to June 2015 in Beijing Tiantan Hospital Affiliated to Capital Medical University, there were 15 cases patients diagnosed as PIMT and trea-ted. The clinical datas of the patients were analyzed retrospectively. The main clinical manifestations,pathological results,clinical treatment and prognosis of the patients and follow-up outcome were analyzed. Results There were 10 males and 5 females,at the age of 39 to 6 8 years old with the median age of 52. Among the 15 cases of patients with PIMT,1 case was recurrence,14 cases were initial treatment. The treatment reason was due to the abnormal physical examination,or cough and sputum with blood,or chest pain,or chest tightness or fever. Chest CT showed that the mass was round or class round, lobulated, part of them showed the burr shape edge. Immunohistochemistry showed that Vimentin positive and smooth muscle actin positive. All patients accept-ed the open chest or thoracoscope surgery. The main operations concluded partial resection,lobectomy or lobecto-my with lymph node eradication. No perioperative death occured,no complications such as postoperative bleed-ing,bronchial pleural fistula and other complications happened. The average follow-up time was from 8 to 58 months. Follow-up rate was 100. 0%（15/15）. There was no tumor recurrence. Conclusion The clinical mani-festations of the pulmonary inflammatory myofibroblastic tumor is complex. The PIMT should be confirmed by pathologic examination,the main treatment is surgical resection with good prognosis and lower recurrence.