CAJ | 학술논문

目的本文回顾性总结中国医学科学院肿瘤医院胸外科手术治疗89例肺硬化性血管瘤(PSH)的经验.方法自2001年1月至2010年12月,89例经病理确诊的PSH患者接受手术治疗,回顾性分析其临床特点、影像学检查、病理诊断、手术治疗方法等资料.结果本组89例PSH患者中,男11例,女78例,男女比例约为1∶7.患者年龄为24 ～71岁,中位年龄为51岁,好发年龄段为41 ～60岁(50.6％).53例患者(59.6％)无任何症状,其余36例患者(40.4％)出现咳嗽(30.3％)、痰中带血(24.7％)等非特异性症状.本组共切除了92个PSH病灶,最大径为0.3 ～6.0 cm,中位最大径为2.3 cm;38％位于右肺下叶,26.1％位于右肺中叶.根据术前影像学检查,只有不到1/3的病变诊断为PSH可能性大；5例行PET-CT检查的患者中,1例误诊为恶性肿瘤.47处PSH病灶采取肿瘤剥除,29处楔形切除,14处肺叶切除,2例全肺切除.结论 PSH术前难以获取明确的病理诊断.术中冰冻切片病理学检查有一定的错误率和延迟诊断率,可能会导致一部分患者接受不必要的扩大切除.手术切除是PSH惟一有效的治疗方法,手术方式以完整切除肿瘤同时尽可能保留肺组织为原则.
목적 본문회고성총결중국의학과학원종류의원흉외과수술치료89례폐경화성혈관류(PSH)적경험.방법 자2001년1월지2010년12월,89례경병리학진적PSH환자접수수술치료,회고성분석기림상특점、영상학검사、병리진단、수술치료방법등자료.결과 본조89례PSH환자중,남11례,녀78례,남녀비례약위1∶7.환자년령위24 ～71세,중위년령위51세,호발년령단위41 ～60세(50.6％).53례환자(59.6％)무임하증상,기여36례환자(40.4％)출현해수(30.3％)、담중대혈(24.7％)등비특이성증상.본조공절제료92개PSH병조,최대경위0.3 ～6.0 cm,중위최대경위2.3 cm;38％위우우폐하협,26.1％위우우폐중협.근거술전영상학검사,지유불도1/3적병변진단위PSH가능성대；5례행PET-CT검사적환자중,1례오진위악성종류.47처PSH병조채취종류박제,29처설형절제,14처폐협절제,2례전폐절제.결론 PSH술전난이획취명학적병리진단.술중빙동절편병이학검사유일정적착오솔화연지진단솔,가능회도치일부분환자접수불필요적확대절제.수술절제시PSH유일유효적치료방법,수술방식이완정절제종류동시진가능보류폐조직위원칙.
Objective As a rare benign lung tumor,pulmonary sclerosing hemangioma (PSH)occurs predominantly in Asian women in their fifth and sixth decades of life.PSH is considered to be evolved from primitive undifferentiated respiratory epithelium.In this study,we summarized our experience in 89 cases of PSH.Method There were a total of 89 patients who received surgical resection and were histopathologically diagnosed as PSH during the period January 2001 to December 2010 in department of thoracic surgery,Cancer Institute and Hospital,Peking Union Medical College and Chinese Academy of Medical Sciences. The clinical data of these patients including symptoms,disease courses,image characteristics and surgical procedures were collected and reviewed retrospectively.Results The PSHs were most frequently (50.6％ ) found in the patients aged 41 to 60 years with a median age of 51 years ( range:24 -71),and the sex ratio (male/female) was approximately 1:7 in this series.In the 89 patients,53 (59.6％ ) were asymptomatic while the other 36 (40.4％ ) had some non-special symptoms such as cough (30.3％ ),hemoptysis(24.7％ ).There were only 3 cases (3.4％ ) with multiple PSHs,4 cases (4.5％ )combined with synchronous primary lung cancer,and 13 cases ( 14.6％ ) with lesions located in the hilar region.The median diameter of the 92 lesions was 2.3 cm (range:0.3 -6.0 cm ),of which 38 ％ located in the right lower lobe and 26.1％ in the right middle lobe,and only about 1/3 were assumed as PSHs preoperatively based on CT imaging. One of the five patients who underwent PET-CT scan had been misdiagnosed as malignant.Of the 92 lesions,47 were resected by enucleation,29 by wedge resection,14 by lobectomy,and 2 by pneumonectomy.Conclusion PSH frequently occurs in the middle-aged women.Most individuals with PSH are asymptomatic or have some non-specific symptoms.Their lesions are usually found accidentally by chest imaging.Although PSH often shows typical imaging characteristics of benign neoplasm of the lung,it is difficult to establish a defined pathological diagnosis preoperatively. The significant error or deferred rate of intraoperative frozen-section evaluation for PSH may result in some unnecessarily extensive surgical procedures.The complete surgical resection is considered the only effective treatment for PSH,and the normal pulmonary tissue should be reserved as possible.