支气管脂肪瘤诊断治疗及预后分析

Clinical characteristics,diagnosis,treatment and prognosis of endobronchial lipoma

目的:探讨支气管脂肪瘤的临床特征、诊治方法和预后。方法:回顾性分析收治的12例支气管脂肪瘤患者的临床特征、诊治过程及预后。结果:12例患者均经组织病理学确诊。其中男10例,女2例;平均年龄(58.92±10.89)岁;主要临床症状包括:咳嗽10例(83.33%),胸闷气短6例(50.00%),发热3例(25.00%),咳痰3例(25%),胸痛2例(16.67%),痰中带血1例(8.33%),乏力1例(8.33%)。影像学主要表现为气管、支气管内块影、肺不张、气道狭窄、伴纵膈淋巴结肿大。仅4例(33.33%)胸CT表现病变密度同脂肪,影像学首诊为支气管脂肪瘤。2例患者胸CT并未出现气管支气管管腔内病灶,于常规行气管镜检查发现病灶。12例患者行气管镜检查,病变位于右肺7例、左肺5例,镜下表现多为圆形、表面光滑血管增生,可造成支气管堵塞或狭窄。12例患者中支气管镜下介入治疗9例,手术2例,支气管镜下介入+手术1例。经上述处理后12例患者全部治愈。结论:支气管脂肪瘤是临床相对少见的一种良性肿瘤,易被误诊。以男性、右肺多见,临床表现不特异、影像学特征为气管支气管管腔内新生物,与脂肪密度相当,支气管镜下多为带蒂的表面光滑新生物,确诊主要依赖于组织病理学,气管镜下介入治疗是首选的治疗方式,然而对于内镜无法完全清除、合并有肺部或纵膈病变者,需手术可以达到完全切除的目的。

Objective:To investigate the clinical features,diagnosis,treatment and prognosis of endobronchial lipoma.Methods:The clinical characteristics,diagnosis and treatment process,and prognosis of 12 patients with bronchial lipoma were retrospectively analyzed.Results:A total of 12 patients were diagnosed by histopathology.There were 10 males and 2 females,the average age was 58.92±10.89 years.Main clinical symptoms included:cough in 10 cases(83.33%),chest tightness and shortness of breath in 6 cases(50.00%),fever in 3 cases(25.00%),expectoration in 3 cases(25%),chest pain in 2 cases(16.67%),blood in sputum in 1 case(8.33%),fatigue in 1 case(8.33%).Imaging manifestations were mainly trachea,endobronchial mass,atelectasis,airway stenosis,with mediastinal lymph node enlargement.Only 4 cases(33.33%) showed that the density of lesions on chest CT was the same as fat,and the first diagnosis was endobronchial lipoma by imaging.There were no lesions in the tracheobronchial lumen on chest CT in 2 patients,but the lesions were found by routine bronchoscopy.Bronchoscopy was performed in 12 patients,and the lesions were located in the right lung in 7 cases and in the left lung in 5 cases.Under the microscope,most of the lesions were round,smooth surface vascular proliferation,which could cause bronchial blockage or stenosis.Among the 12 patients,9 cases were treated with bronchoscopy,2 cases were operated,and 1 case was treated with bronchoscopy combined with surgery.All 12 patients were cured after the above treatment.Conclusion:Endobronchial lipoma is a relatively rare benign tumor in clinical practice and is easily misdiagnosed.It is more common in males and the right lung,and clinical manifestations are not specific.The imaging features are neoplasms in the tracheobronchial lumen,which have a similar density to fat.Bronchoscopy is mostly a pedunculated neoplasm with a smooth surface.The diagnosis mainly depends on histopathology.Interventional bronchoscopy is the preferred treatment method.For patients with pulmonary or mediastinal lesions that cannot be completely removed by endoscopy,surgery can be achieved to complete resection.