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目的探讨分析肺错构瘤的诊治经验。方法对2006年1月至2010年12月手术治疗的140例肺错构瘤患者的临床特点、术前诊断方法、手术治疗方法等进行回顾性总结。结果本组140例肺错构瘤患者中,男60例,女80例,男女比例为3:4。患者年龄为27～77岁,中位年龄为53岁,好发年龄段为41～60岁(69.3%,97/140)。中心支气管内型肺错构瘤3例,占2.14%(3/140)。大多数患者无任何症状(80.7%),少数患者因出现咳嗽、痰血、气短等非特异性症状就诊发现(19.3%)。本院胸片、CT和术前诊断肺错构瘤的准确率分别为2.7%、46.7%、42.1%。手术切除方式包括肿瘤剥除66例、肺楔形切除66例、肺叶切除7例、全肺切除1例。全组患者无围手术期死亡发生。2例患者术后发生并发症,1例切口感染、1例Ⅱ型呼吸衰竭,均治愈出院。结论肺错构瘤好发于中老年人群,多无症状或无特异性症状,胸部影像学检查偶然发现。影像学上需要与原发肺癌和肺转移瘤鉴别,尽管肺错构瘤可以出现特征性的影像学表现,大部分患者术前难以获得明确诊断。手术方式以完整切除肿瘤同时尽可能保留肺组织为原则。
Objective To investigate the diagnosis and treatment of pulmonary hamartoma. Methods The clinical features, preoperative diagnosis and surgical treatment of 140 patients with pulmonary hamartoma underwent surgical treatment from January 2006 to December 2010 were reviewed retrospectively. Results 140 cases of pulmonary hamartoma patients, 60 males and 80 females, male to female ratio of 3: 4. Patients ranged in age from 27 to 77 years, with a median age of 53 years and a well-tolerated age range of 41-60 years (69.3%, 97/140). Central bronchial hamartoma in 3 cases, accounting for 2.14% (3/140). Most patients without any symptoms (80.7%), a small number of patients due to cough, sputum blood, shortness of breath and other non-specific symptoms were found (19.3%). The accuracy of chest radiography, CT and preoperative diagnosis of pulmonary hamartoma were 2.7%, 46.7% and 42.1% respectively. Surgical resection included tumor removal in 66 cases, wedge resection in 66 cases, lobectomy in 7 cases and pneumonectomy in 1 case. All patients without perioperative deaths. Two patients had postoperative complications, one incision infection, and one type Ⅱ respiratory failure. All patients were cured and discharged. Conclusions Pulmonary hamartoma occurs in middle-aged and elderly people with many asymptomatic or nonspecific symptoms. Chest radiography is found accidentally. Imaging needs to be differentiated from primary lung and metastatic lung tumors. Although characteristic imaging features of pulmonary hamartomas appear, most patients have difficulty obtaining a definitive diagnosis before surgery. Surgical approach to complete resection of the tumor while retaining the principle of lung tissue.