CAJ | 학술논문

目的分析肺脂肪瘤的流行病学特征及临床特点,提高临床医师对肺脂肪瘤的诊治水平.方法报道宁波大学附属医院呼吸科1例经病理确诊支气管脂肪瘤病例并对国内54例肺脂肪瘤病例进行回顾性分析.结果患者女性,57岁,因“咳嗽、咯痰2个月,发热3周”于2010年8月24日入院,当地医院考虑“肺炎”,给予抗菌药物治疗,疗效欠佳转入我院.入院后行纤维支气管镜检查发现左下叶开口处肿物,后转入胸外科手术治疗,确诊为支气管脂肪瘤.到目前为止,国内能检索到的确诊为肺脂肪瘤的病例共54例.54例患者包括男性44例,女性10例,平均年龄(51.7±11.6)岁,支气管内脂肪瘤44例,肺内脂肪瘤10例,48例患者存在症状,主要症状无特异性,包括咳嗽、咯痰、发热、气促、咯血.50例患者存在异常影像表现,肺不张26例,渗出或实变13例,肿块18例,CT扫描下肿块呈低密度灶,CT值范围在-83～-122 Hu之间.23例患者行纤维支气管镜检查,但仅有6例(26.1％)得到正确诊断.34例患者描述手术方式,其中3例进行内镜下切除,术后恢复良好.结论肺脂肪瘤以中老年男性为主；胸部CT发现脂肪密度肿块,需考虑脂肪瘤；硬质支气管镜镜下切除为支气管腔内脂肪瘤首选的治疗方式,肺内脂肪瘤或支气管脂肪瘤已发生肺实质的不可逆损害应手术切除.
목적 분석폐지방류적류행병학특정급림상특점,제고림상의사대폐지방류적진치수평.방법 보도저파대학부속의원호흡과1례경병리학진지기관지방류병례병대국내54례폐지방류병례진행회고성분석.결과 환자녀성,57세,인“해수、각담2개월,발열3주”우2010년8월24일입원,당지의원고필“폐염”,급여항균약물치료,료효흠가전입아원.입원후행섬유지기관경검사발현좌하협개구처종물,후전입흉외과수술치료,학진위지기관지방류.도목전위지,국내능검색도적학진위폐지방류적병례공54례.54례환자포괄남성44례,녀성10례,평균년령(51.7±11.6)세,지기관내지방류44례,폐내지방류10례,48례환자존재증상,주요증상무특이성,포괄해수、각담、발열、기촉、각혈.50례환자존재이상영상표현,폐불장26례,삼출혹실변13례,종괴18례,CT소묘하종괴정저밀도조,CT치범위재-83～-122 Hu지간.23례환자행섬유지기관경검사,단부유6례(26.1％)득도정학진단.34례환자묘술수술방식,기중3례진행내경하절제,술후회복량호.결론 폐지방류이중노년남성위주；흉부CT발현지방밀도종괴,수고필지방류；경질지기관경경하절제위지기관강내지방류수선적치료방식,폐내지방류혹지기관지방류이발생폐실질적불가역손해응수술절제.
Objective To study the epidemiology and clinical characteristic of pulmonary lipoma.Methods A case of endobronchial lipoma in our hospital was reported.And moreover,we conducted a retrospective analysis of 54 cases of pulmoary lipoma in China.Results The patient admitted to our hospital due to productive cough for two months and fever for three weeks.And she had received antiinfective therapy before admission.A fiberoptic bronchoscopy was performed,and a polypoid tumor was found in the left of lower bronchus.The patient was finally diaghosed as pulmoary lipoma.In addition,we carried out a search in databases and we found that 54 cases had been reported in our country.Of those patients:44 man and 10 women; average(51.7± 11.60)years old;histology:endobronchial lipomas 44 cases,peripheral intrapulmonary lipoma 10 cases.Most symptoms of those patients including cough,sputum,elevated temperature,dyspnea and hemoptysis.Abnormal radiographic findings were reported for 50 patients:atelectasis 26 cases,infiltration or consolidation 13 cases,mass 18 cases.The value of CT scan of the lesions was range from-83 to-122 Hu.Only six patients had final diagnosis among 23 patients by flexible bronchoscopy.Thirty-four patients recorded surgical resection methods,and bronchoscopic resection was carried out in three patients.Conclusions Pulmonary lipoma is usually found in old man.The doctors should pay attention to a mass in CT scan,especially in those whose value of CT scan is negative.The endoscopic technique is effective for the diagnosis and treatment of endobronchial lipomas.Surgical therapy is recommended for patients who have permanent lung destruction or those in peripheral intrapulmonary lipoma.