良性肺结节的临床特点及其诊断和治疗

Clinical features,diagnosis and treatment of benign pulmonary nodules

目的分析良性肺结节(直径≤2 cm)的临床特点,提高肺结节诊断的精确性。方法收集和分析2013—2018年在大连大学附属中山医院胸外科接受手术治疗的良性肺结节患者的临床资料,并与同期手术的恶性肺结节的影像学特点进行对比。结果共有良性肺结节患者104例(良性率占22.7%)。病理诊断机化性肺炎43例、肉芽肿17例、错构瘤和非典型腺瘤样增生(AAH)各14例、淋巴结增生7例、炎性假瘤6例、硬化性肺细胞瘤2例、结核性肉芽肿合并AAH 1例。无症状就诊患者39例,主诉胸痛者33例、咳嗽13例、咳嗽咳痰11例、胸闷7例、发热1例;术前观察时间平均7个月(1周~6年),17个结节有增大或密度增加;26例患者肿瘤标志物轻度增高。CT影像表现结节形态不规则者19例,具有毛刺征者20例、分叶征11例、胸膜凹陷16例、钙化11例、血管集束征9例、空泡征9例、胸膜增厚8例、支气管通气征7例。与同期手术的354例恶性结节(原发性肺癌)比较发现,良性结节多为实性(P≤0.001)、直径≤10 mm(P=0.003);同时胸膜凹陷及血管集束征的发生率较低(P≤0.001;P=0.013);良恶性结节均好发于上叶肺。结论手术切除的良恶性肺结节的影像学特点有相似之处,胸膜凹陷和血管集束征更具鉴别意义。对直径≤1 cm的实性肺结节,应给予更大耐心。

Objective To analyze the clinical features of benign pulmonary nodules(≤2 cm in diameter),and to improve the accurate diagnosis of pulmonary nodules.Methods The clinical data of patients with benign pulmonary nodules accepted by Zhongshan Hospital of Dalian University from 2013 to 2018 were analyzed,and the clinical data were compared with those of patients with malignant pulmonary nodules at the same period.Results There were 104 patients with benign pulmonary nodules in total(with a benign rate of 22.7%).After pathological diagnosis,43 cases of organizing pneumonia,17 cases of granuloma,14 cases of hamartoma,14 cases of atypical adenomatous hyperplasia(AAH),7 cases of lymph node hyperplasia,6 cases of inflammatory pseudotumor,2 cases of sclerosing pulmonary cell tumor and one case of tuberculous granuloma complicated with AAH were found.Among the 104 patients,39 patients were asymptomatic;33 cases complained of chest pain,13 cases of cough,11 cases of cough and sputum,7 cases of chest tightness and 1 case of fever.After the average preoperative observation time of 7 months(from 1 week to 6 years),17 pulmonary nodules enlarged or increased in density;blood tumor markers increased slightly in 26 patients.The imaging findings on CT showed that 19 cases were with irregular nodular morphology,20 cases with spicule sign,11 cases with lobulation,16 cases with pleural indentation,11 cases with calcification,9 cases with vessel convergence,9 cases with vocule sign,8 cases with pleural thickening,and 7 cases with air bronchogram.Compared with 354 cases of malignant nodules(primary lung cancer)operated at the same time,more benign nodules were solid(P≤0.001),with a diameter≤10 mm(P=0.003)and the incidences of pleural indentation and vessel convergence were significantly lower(P≤0.001,P=0.013).Both benign and malignant pulmonary nodules were more common in upper lobes.Conclusions The imaging characteristics of benign and malignant pulmonary nodules are similar while vascular clustering and pleural indentation are more differentiated.Greater patience should be given to solid pulmonary nodules(≤10 mm in diameter).