先天性支气管囊肿41例临床特征分析

Analysis of clinical characteristics of 41 cases of congenital bronchial cyst

目的:提高临床医师对先天性支气管囊肿(BC)的认识及诊治水平。方法:回顾性分析2003年3月至2020年6月广西医科大学第一附属医院收治的41例BC患者的临床资料。结果:41例患者中男19例,女22例,平均年龄(37±17)岁,63.4%为≤44岁的青年人;肺内型8例,纵隔型31例,异位型2例;主要临床症状为咳嗽咳痰(26.8%)、胸痛(36.6%),部分患者无症状(29.3%),阳性体征有语音震颤及呼吸音减弱(9.8%)、胸壁压痛(7.3%)、面部水肿(2.4%);实验室检查和肺功能无明显异常。影像学主要表现为孤立的、边缘光整、密度均匀、薄壁球型囊肿,增强扫描一般无强化或囊壁轻度强化。误诊率为92.7%,分别误诊为肿瘤、肺大疱、肺结核、心包囊肿、食管巨大憩室、鳃裂囊肿等;41例均经病理学确诊,光镜下均见囊壁内衬假复层纤毛柱状上皮,可见支气管组织,其中液性囊肿36例。40例采取手术切除囊肿,1例内科介入及对症处理,37例治愈,4例好转。结论:先天性BC以青年病例多见,临床表现多与囊肿压迫、合并感染或其他基础疾病相关,影像学示占位性病变及镜下见囊壁内衬假复层纤毛柱状上皮是诊断本病的临床依据,若无手术禁忌,所有BC患者均应优先考虑手术治疗,预后较好。

Objective:To improve the clinicians’cognition,diagnosis and treatment of congenital bronchial cyst(BC).Methods:The clinical data of 41 patients with BC treated in our hospital from March 2003 to June 2020 were analyzed retrospectively.Results:Among the 41 patients,there were 19 males and 22 females,with an average age of(37±17)years.63.4%of whom were young patient≤44 years old,8 cases of intrapulmonary type,31 cases of mediastinal type and 2 cases of ectopic type.The main clinical symptoms were cough and sputum(26.8%),chest pain(36.6%),some patients were asymptomatic(29.3%).Positive signs were vocal fremitus and decreased respiratory sound(9.8%),chest wall tenderness(7.3%),facial edema(2.4%).Laboratory examination and lung function were not significantly abnormal.The main imaging manifestations were isolated,smooth edge,uniform density,thin-walled spherical cyst,generally no enhancement or mild enhancement of the cyst wall in enhancement scan.The misdiagnosis rate was 92.7%,which was misdiagnosed as tumor,bullae of lung,tuberculosis,pericardial cyst,large diverticulum of esophagus,branchial cleft cyst and so on.41 cases were confirmed pathologically,and pseudostratified ciliated columnar epithelium was observed under light microscope,bronchial tissue can be observed,including 36 cases of liquid cyst.Surgical resection of cysts was performed in 40 cases,1 case received medical intervention and symptomatic treatment,37 cases were cured and 4 cases were improved.Conclusion:Congenital BC is most common in young patients,and its clinical manifestations are mostly related to cyst compression,concurrent infection or other basic diseases.Imaging shows that space-occupying lesions and pseudostratified ciliated columnar epithelium in the cyst wall under microscope are the clinical basis for the diagnosis of this disease.If there is no surgical taboo,all patients with BC should give priority to surgical treatment,and patients may have a good prognosis.