胸膜孤立性纤维瘤的诊治体会

DIAGNOSIS AND TREATMENT OF SOLITARY FIBROUS TUMOR OF THE PLEURA

目的：探讨胸膜孤立性纤维瘤的临床特点、诊断、治疗及预后。方法：回顾性研究内蒙古医科大学附属医院2005-01-2015-12治疗的45例胸膜孤立性纤维瘤病人的临床表现、病理资料、手术方法及预后。结果：45例病人中,男性28例,女性17例,平均年龄为57.6岁;所有病人均无石棉接触史;术前CT诊断率40%,误诊率60%;穿刺诊断率47%;44例行手术治疗,其中胸腔镜手术19例（43.2%）,开胸手术25例（56.8%）,均完整切除肿瘤手术切除率100%。1例不能耐受手术者随访观察病情平稳。术后免疫组化：CD34阳性率95.5%、Vim阳性率82.2%、bcl-2阳性率82.2%、所有病人随访观察,其中失访3例,其余41例手术病人1-9a均未见复发。结论：胸膜孤立性纤维瘤临床中罕见,术前误诊率高,手术是主要的治疗手段,诊断主要依靠病理检查。术后预后一般较好。

Objective：To investigate the clinical features of solitary fibrous tumor of the pleura,di-agnosis, treatment and prognosis. Methods：A retrospective study of the clinical manifestations of Affiliated Hospital of Inner Mongolia Medical University January 2005 to December 2015 treated 45 cases of pleural solitary fibrous tumor patients, pathological data, surgical methods and prognosis. Result：Among 45 patients,28males and 17 females,mean age 57. 6years;all patients had no history of exposure to asbestos;preoperative CT diagnosis rate of 40% misdiagnosis rate of 60%;invasive diagnostic rate of 47%;44routine surgery, thoracic surgery in which 19 cases （43. 2%）, thoracic surgery 25 cases（56. 8%）,are the complete removal of the tumor resection rate was100%. One case we can not tolerate surgery follow-up observation of stable disease. After immunohistochemistry：CD34 positive rate of 95. 5%,Vim positive rate of 82. 2%,bcl-2positive rate of 82. 2%,follow-up study in which all patients were lost to follow three cases,and the remaining 41 cases of surgical patients1-9 annual no recurrence. Conclusion：The diagnosis of pleural solitary fibroids in clinical rare,high rate of preoperative misdiagnosis,diagnosis depends mainly on pathological examination. Surgery is the main treatment,postoperative prognosis is generally better.