肺结节16例诊治体会并文献复习

Treatment experience and literature review in 16 cases of pulmonary nodules

目的 初步探讨如何建立早期诊断肺部结节正确的临床思维和方法。方法 选取2012 年1月至2017年7月我院肺部结节患者16例,所有患者予以完善胸部高分辨率 CT、肿瘤标志物检测、支气管镜检查或经皮肺穿刺等,最后行手术病理获得明确诊断。结果 16例肺结节患者中原位癌 2例,腺癌7例,鳞癌1例,类癌1例,结核3例,肺组织纤维化1例,慢性间质性炎症1例。恶性病 变为68.7% （11/16）,非恶性病变为31.3% （5/16）。结论 肺部结节是否恶性与有无危险因素,以及 结节的大小、多发或单发、有无血管滋养、结节内有无微血管相通、是否有毛刺以及实性成分所占比 例有关,因此综合高分辨率 CT、支气管镜检查、经皮肺穿刺、肿瘤标志物检 测,合 理 选 择 随 访 或 手 术治疗切除,对肺部结节患者的预后影响较大。

Objective To explore initially the correct clinical thinking and method of early diagnosis of pulmonary nodule. Methods 16 patients with pulmonary nodule were enrolled during January 2012 to July 2017. All patients were examined with high resolution computerized tomography, tumor markers, and bronchoscopy or percutaneous lung biopsy. The diagnosis was defined by surgery and pathology. Results There were two cases of carcinoma in situ, seven cases of adenocarcinoma, one case of squamous cell carcinoma, one case of carcinoid, three cases of tuberculosis, one case of pulmonary fibrosis and one case of chronic interstitial pneumonia. Malignant tumor accounted for 68.7~ （11/16）, others were 31.3% （5/ 16）. Conclusions The malignancy of pulmonary nodule or not is related to risk factors, nodule size, solitary or multiple, signs of vascular convergence, microvascular combination inside the nodule, spiculation and the solid proportion. Hence, the compositive examination of high resolution computerized tomography, bronchoscopy, percutaneous lung biopsy and tumor markers, reasonable choice of follow-up or surgical incision will bring great influence for the prognosis of pulmonary nodule patients.