中华临床医师杂志（电子版）
中華臨床醫師雜誌（電子版）
중화림상의사잡지（전자판）
CHINESE JOURNAL OF CLINICIANS(ELECTRONIC VERSION)
2013年
5期
1953-1960
,共8页
孤立性纤维瘤,胸膜%诊断%外科手术%胸腔镜检查
孤立性纖維瘤,胸膜%診斷%外科手術%胸腔鏡檢查
고립성섬유류,흉막%진단%외과수술%흉강경검사
Solitary fibrous tumor,pleural%Diagnosis%Surgical procedures,operative%Thoracoscopy
目的探讨胸膜孤立性纤维瘤（ SFTP ）的临床表现、诊断与治疗的特点。方法回顾性分析北京协和医院胸外科2004年1月至2012年9月收治的20例SFTP的临床及影像学、病理学资料，所有患者均行手术治疗，术后规律随访。结果本组患者男9例，女11例；年龄19～73岁，中位年龄54.5岁。就诊时10例无症状，另10例有胸痛、胸闷、咳嗽等不同症状。所有患者术前常规实验室检查及肿瘤标记物均未见明显异常。所有患者术前均行CT影像学检查，影像学误诊率为85％（17/20），临床误诊率为65％（13/20）。20例患者均行手术治疗，其中常规后外侧开胸手术治疗10例（50％），电视胸腔镜手术者10例，其中5例为VATS联合小切口手术治疗。患者均完整切除肿瘤，手术切除率为100％。其中肿瘤直径＞10 cm患者，手术时间与出血量均与＜10 cm者有统计学差异（P＜0.05）。20例患者中，17例均诊断为单纯良性SFTP，2例诊断为恶性SFTP，1例为良性SFTP合并肺腺癌。所有患者术后均规律复查，随访1～84个月，中位随访32个月，均未出现手术并发症。结论 SFTP临床少见，容易误诊，主要治疗手段为根治性切除，肿瘤大小与手术时间和出血量关系密切，其确诊主要依靠免疫组化分析，除恶性SFTP外，总体远期预后较好。
目的探討胸膜孤立性纖維瘤（ SFTP ）的臨床錶現、診斷與治療的特點。方法迴顧性分析北京協和醫院胸外科2004年1月至2012年9月收治的20例SFTP的臨床及影像學、病理學資料，所有患者均行手術治療，術後規律隨訪。結果本組患者男9例，女11例；年齡19～73歲，中位年齡54.5歲。就診時10例無癥狀，另10例有胸痛、胸悶、咳嗽等不同癥狀。所有患者術前常規實驗室檢查及腫瘤標記物均未見明顯異常。所有患者術前均行CT影像學檢查，影像學誤診率為85％（17/20），臨床誤診率為65％（13/20）。20例患者均行手術治療，其中常規後外側開胸手術治療10例（50％），電視胸腔鏡手術者10例，其中5例為VATS聯閤小切口手術治療。患者均完整切除腫瘤，手術切除率為100％。其中腫瘤直徑＞10 cm患者，手術時間與齣血量均與＜10 cm者有統計學差異（P＜0.05）。20例患者中，17例均診斷為單純良性SFTP，2例診斷為噁性SFTP，1例為良性SFTP閤併肺腺癌。所有患者術後均規律複查，隨訪1～84箇月，中位隨訪32箇月，均未齣現手術併髮癥。結論 SFTP臨床少見，容易誤診，主要治療手段為根治性切除，腫瘤大小與手術時間和齣血量關繫密切，其確診主要依靠免疫組化分析，除噁性SFTP外，總體遠期預後較好。
목적탐토흉막고립성섬유류（ SFTP ）적림상표현、진단여치료적특점。방법회고성분석북경협화의원흉외과2004년1월지2012년9월수치적20례SFTP적림상급영상학、병이학자료，소유환자균행수술치료，술후규률수방。결과본조환자남9례，녀11례；년령19～73세，중위년령54.5세。취진시10례무증상，령10례유흉통、흉민、해수등불동증상。소유환자술전상규실험실검사급종류표기물균미견명현이상。소유환자술전균행CT영상학검사，영상학오진솔위85％（17/20），림상오진솔위65％（13/20）。20례환자균행수술치료，기중상규후외측개흉수술치료10례（50％），전시흉강경수술자10례，기중5례위VATS연합소절구수술치료。환자균완정절제종류，수술절제솔위100％。기중종류직경＞10 cm환자，수술시간여출혈량균여＜10 cm자유통계학차이（P＜0.05）。20례환자중，17례균진단위단순량성SFTP，2례진단위악성SFTP，1례위량성SFTP합병폐선암。소유환자술후균규률복사，수방1～84개월，중위수방32개월，균미출현수술병발증。결론 SFTP림상소견，용역오진，주요치료수단위근치성절제，종류대소여수술시간화출혈량관계밀절，기학진주요의고면역조화분석，제악성SFTP외，총체원기예후교호。
Objective To investigate the characters of clinical manifestation , diagnosis and treatment of solitary fibrous tumor of the pleura ( SFTP).Methods 20 patients′data with diagnosis of SFTP in Peking Union Medical College Hospital were retrospectively analyzed from January 2004 to September 2012 .All the information of each patient had been collected including clinical manifestation ,imaging and pathological characters .All the patients were performed thoracic surgery and were in routine follow-up.Results The group contains 9 male and 11 female with age ranging from 19 to 73,the median age was 54.5 years.10 cases were asymptomatic while other 10 cases had chest pain,chest distress,cough and other symptoms.All patients with preoperative routine laboratory tests and tumor markers were not seen obvious anomaly .All patients were performed with preoperative CT scan ,but the misdiagnosis rate was 85%(17/20)with only the imaging information.The clinical misdiagnosis rate was 65%(13/20).All the patients were performed thoracic surgical treatment , including conventional posterolateral thoracotomy surgical treatment of 10 cases(50%)and video-assisted thoracoscopic surgery of 10 cases,of which 5 cases of VATS in combination with small incision surgery .The patients were complete radical resection of the tumor , surgical removal rate was 100%.There were significant difference of operation time and the amount of bleeding between the tumor ′s diameter greater than 10 cm patients and less than 10 cm(P <0.05).Amount the 20 patients,17 cases were diagnosed pure benign SFTP while 2 cases were diagnosed as malignant SFTP and one case of benign SFTP with pulmonary adenocarcinoma .All of the patients were in routine follow-up procedure from 1 to 84 months,a median follow-up time was 32 months.All the patients recovered without complications .Conclusions SFTP is a rare tumor which will be misdiagnosed easily .The main treatment method is radical resection .Tumor size might be an essential factor for the amount of bleeding and operation time .The accurate diagnosis relies mainly on the immunohistochemical analysis.Except the malignant SFTP ,the long-term prognosis of benign SFTP is good .
