目的：探讨肺硬化性血管瘤的临床特征，分析误诊原因，以减少误漏诊。方法回顾性分析我院2014年4月—2015年4月收治的10例经病理学检查确诊的肺硬化性血管瘤的临床资料。结果本组10例，4例体检发现，6例因左肾盂结石、左肾重度积水及咳嗽、咳痰并痰中带血、发热、胸闷、胸痛、刺激性干咳等症状就诊。影像学检查主要表现为肺部孤立、境界清楚的圆形或类圆形结节影、肿块，瘤体平均最大直径2．7 cm，均为单发，发生在左肺4例（上叶3例，下叶1例），右肺6例（上叶1例，中叶1例，下叶4例）。本组术前仅1例行经皮肺穿刺活组织病理检查术诊断为肺硬化性血管瘤，余9例均诊断为肺部占位性质待查。本组7例行胸腔镜手术，3例行开胸手术；5例行肺肿块楔形切除术，5例行肺叶切除术，2例行纵隔、肺门及隆突下淋巴结清扫。10例术中行快速冷冻病理切片检查，6例提示良性病变，1例良恶性不能判定，1例提示炎性病变，2例提示肺癌，术后常规病理检查均诊断为肺硬化性血管瘤。本组术后均恢复良好，切口愈合后出院。随访5～17个月，均无复发和转移。结论肺硬化性血管瘤发病率低，临床及影像学表现缺乏特异性，误诊率较高。提高对该病认识、及时进行相关医技检查、仔细鉴别诊断及综合全面分析病情可避免或减少肺硬化性血管瘤误诊误治。%Objective To investigate the clinical features of the pulmonary sclerosing hemangioma (PSH) and ana-lyze the causes of misdiagnosis , in order to reduce the occurrence of misdiagnosis and missed diagnosis .Methods The clini-cal data of 10 patients confirmed by pathological examination of PSH in the Cancer Center , Renmin Hospital of Wuhan Univer-sity during April 2014 and April 2015 were analysed retrospectively .Results Of the 10 patients, 4 patients were detected in routine medical examinations , while 6 patients presented clinical symptoms , including renal pelvis calculus , severe hydrone-phrosis, cough, hemoptysis, fever, chest pain, chest stuffiness and irritating cough , etc.The imaging examination revealed round or similar isolated nodules with distinct margins and lump in the lungs , and the average tumor diameter was 2.7 cm.Le-sions of the 10 patients were single nodule, four lesions arose in the left lung (3 in left upper lobe, 1 in left lower lobe), 6 in the right (1 in right upper lobe, 1 in right middle lobe, 4 in right lower lobe).One patient underwent preoperative transtho-racic needle biopsy with a histopathological diagnosis of PSH;the remaining 9 cases were diagnosed as lung occupying lesions . All the patients underwent surgical resection , 7 patients underwent video-assisted thoracoscopes surgery , 3 underwent tradi-tional open surgery;wedge resection was carried out in 5 patients and the other 5 underwent lobectomy , mediastinal , hilar and subcarinal lymph nodes dissection were performed in 2 patients.Intraoperative frozen-section assessment was undertaken in 10 patients, all of whom were diagnosed with PSH by postoperative routine pathologic examination .The results of intraoperative frozen-section revealed that 6 cases were diagnosed as benign lesions , 1 case could not be identified whether it was a benign or malignant lesion , 1 case as a inflammatory lesion , 2 cases as lung cancer .All patients recovered well after the operation , and were discharged from the hospital with good wound healing .There was no recurrence and metastasis during follow-ups of 5-17 months.Conclusion Clinical and radiological characteristics of PSH are nonspecific .The incidence rate of PSH is low , and the misdiagnosis rate is high .Improving the awareness of PSH , undergoing timely relevant medical examinations , paying more attention to the differential diagnosis and analyzing the condition of patients comprehensively may contribute to avoiding or reducing the misdiagnosis and mis-treatment of PSH .
展开▼
