目的 了解气管支气管脂肪瘤临床特征,分析误诊原因,寻求早期诊断方法及合理诊治方案.方法 回顾分析我院2例气管支气管脂肪瘤及国内文献报道病理检查确诊的38例气管支气管脂肪瘤临床资料.结果 本组40例,22例误诊,误诊率55.0％.误诊为支气管哮喘7例、支气管炎6例、肺炎及肺癌各4例、支气管息肉1例,中位误诊时间12个月.经支气管镜活检病理确诊8例(20.0％),经支气管镜介入治疗后取出气管内肿物病理检查诊断3例(7.5％),行外科手术后病理检查确诊29例(72.5％).误诊原因主要与临床表现无特异性、胸部X线检查未显示气管内肿物、支气管镜活检病理诊断率低等有关.结论 气管支气管脂肪瘤临床诊断困难,胸部CT、MRI等影像学检查可发现气道内肿物,CT值测定有助于诊断.经支气管镜活检病理诊断率较低,需多点活检,必要时行手术探查.本病首选经支气管镜介入治疗.%Objective To learn clinical features of endobronchial lipoma and analyze misdiagnosed causes in order to propose appropriate treatment. Methods Clinical data of 2 patients in our hospital and 38 patients from literature reports in China with endobronchial lipoma were retrospectively analyzed. Results 22 out of 40 (55.0%) patients were misdiagnosed as having bronchial asthma (7 patients) , bronchitis (6 patients) , pneumonia (4 patients), lung cancer (4 patients) and bronchial polyps (1 patient). The middle diagnosis period was 12 months. Bronchial lipoma was definitely diagnosed by the transbronchial biopsy (TBB) specimen (8 patients, 20% ), by bronchoscopic resection and pathology (3 patients, 7.5% ) and by surgical resection and pathology (29 patients, 72.5% ). Misdiagnosis was caused due to non-specific symptoms, no goitre in trachea by chest X-ray examination and the low diagnosis rate of TBB. Conclusion Endobronchial lipoma is difficult to be defined. Chest CT and MRI can show direct shadow of the tumor. CT values are useful for diagnosing endobronchial lipoma, but the accuracy diagnosed rate of bronchial lipoma by TBB is low, and multipoint biopsy or surgical procedure should be considered when necessary. Bronchoscopic resection should be considered as the preferred treatment for endobronchial lipoma.
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