98例肺部单发小结节的临床分析

Clinico-pathological study of 98 patients with pulmonary solitary nodule

目的 研究肺部单发小结节良恶性患者的临床表现和胸部CT特点。方法 分析 98例肺部单发小结节患者的资料 ,对其临床表现和胸部CT特点进行数据资料统计 ,采用卡方分析 ,两组率的差异采用两组率比较的方法。结果 98例患者中 ,肺癌 4 6例 (46 .9% ) ,良性肿瘤 14例(14 .3% ) ,结核球 38例 (38.8% )。无任何症状查体发现小结节和仅伴有咳嗽咯痰症状者 5 6例(5 7.1% ) ,其中 5 0 %为Ⅰ期肺癌患者。年轻、有长期发热、盗汗、胸背痛症状者提示结核 ;无任何症状、仅有咳嗽咳痰、痰中带血或咯血提示恶性肿瘤。胸部CT影像中良性肿瘤发生于中叶或舌叶的比率高 (42 .3% ) ,结节边界清、密度均匀 ;恶性肿瘤多边界不清、密度不均、有毛刺、分叶、胸膜皱缩 ;结核出现于下叶的比率高 ,钙化多见。结论 加强肺癌高危人群的普查、筛查和监测是发现早期肺癌患者的途径 ,对发现的肺部小结节 ,结合临床表现和CT特点可以作出初步诊断。当结节直径 >1cm ,且不能判定良恶性时 。

Objective To arrive at correct diagnosis of pulmonary solitary nodule by clinical manifestations and chest CT scan. Methods Ninety eight patients with pulmonary solitary nodule were treated from 1990 to 2000. Their CT findings with clinical manifestations were correlated with the pathology results. Results Of these 98 patients, there were 46(46.9%)lung cancers, 14(14.3%)benign tumors and 38(38.8%) tuberculosis. Fifty six(57.1%)patients had been asymptomatic or only associated with cough and sputum. 50% of these patients had stage I lung cancer. Tuberculosis was diagnosed more frequently in young patients with protracted feverishness, night sweats, chest and back pain, whereas lung cancer was more common in older patients who were asymptomatic or associated only with cough, sputum and hemoptysis. Lesions with well defined margin, smooth and in the middle lobe by chest CT was suggestive of benign tumor, while those with irregular margin, un even density, spiculated margin, lobulated contour and pleural shrinkage were more commonly associated with lung cancer. Those with calcification and in the lower lobe implied tuberculosis. Conclusion Screening of high risk population is useful in finding early lung cancer. Pulmonary solitary nodule can be correctly diagnosed chiefly by referring to the clinical manifestations and characteristics of chest CT scans. Nodules less than 1cm across are difficult to diagnose and, therefore, exploration is indicated.