手术后病理证实为良性肺结节288例临床病例分析

Clinical characteristics of 288 cases of pathologically confirmed benign pulmonary nodules post-surgery

目的总结经手术后病理证实为良性结节的临床病例特点,为良性结节的鉴别提供依据。方法回顾性分析上海交通大学医学院附属瑞金医院2017年1月1日至2019年10月31日行肺叶或肺段切除术的患者共3231例,其中手术后病理证实为良性结节者288例,共297个结节。收集患者的临床资料,包括患者人口学、病史及影像学资料,通过分析希望筛选出提示良性结节的临床指标,特别是影像学特征。结果良性结节病理类型主要为肉芽肿性炎症(61/288)、错构瘤(47/288)、隐球菌感染(25/288)、机化性肺炎(15/288)及非特异性炎症性病理改变(14/288)。良性结节主要影像表现为单发实性结节,平均直径<10 mm,边界清楚,无空泡征、血管集束征及功能显像阴性。结论被手术切除的良性结节最常见病因为肉芽肿性炎、错构瘤、隐球菌感染,最常见影像学特征为边界清楚的单发实性结节,在进行手术前需仔细鉴别。

Objective To analyze retrospectively the clinical characteristics of pathologically confirmed benign pulmonary nodules post-surgery,and therefore to provide evidence for the diagnosis of benign pulmonary nodules.Methods 288 cases of pulmonary nodules were selected in the Ruijin Hospital from 1st January 2017 to 31st October 2019.All the lesions of these patients were confirmed by surgery and had definite pathological diagnosis.The clinical data were collected,including demography,clinical data,radiological features.Features that indicated benign pulmonary nodules were summarized.Results The main etiologies of benign pulmonary nodules were granulomas,hamartomas,cryptococcus infection,organizing pneumonia and non-specific inflammation.In our cohort,we found that the radiological characteristics of benign nodules were single,solid,less than 10 mm in average diameter,with well-defined margins,absence of vacuole sign or vascular convergence,and negative functional imaging.Conclusion The most common etiologies of post-surgical benign nodules were granulomas,hamartomas,and cryptococcus infection,characterized by being single,solid and with well-defined margins.Caution should be taken before considering surgery for such nodules.