肺不典型腺瘤样增生的诊断和治疗  

Diagnosis and treatment of atypical adenomatous pulmonary hyperplasia in lungs

作　　者：张毅[1] 支修益[1] 陈莉[2] 王大业[4] 李言[3] 王若天[1] 胡牧[1] 刘磊[1] 钱坤[1] 

机构地区：[1]首都医科大学宣武医院胸外科首都医科大学肺癌诊疗中心,北京100053 [2]首都医科大学宣武医院胸外科首都医科大学病理科,北京100053 [3]首都医科大学宣武医院胸外科首都医科大学放射科,北京100053 [4]首都医科大学病理学系

出　　处：《中华医学杂志》2010年第47期3355-3358,共4页National Medical Journal of China

摘　　要：目的 分析肺不典型腺瘤样增生（AAH）的CT影像表现与病理结果作对照,及手术治疗方式,旨在提高对肺AAH诊断和治疗的认识.方法 回顾性分析自2005年1月至2010年6月首都医科大学北京宣武医院胸外科经手术及病理证实的10例AAH的CT影像表现,所有患者均经高分辨率增强CT薄扫,男2例、女8例,年龄36～73岁,平均年龄54.4岁.所有患者均行手术治疗.术中切除标本送冰冻病理决定术式,术后所有病理标本均经HE染色和免疫组织化学染色为最后诊断,将影像学结果与病理学结果进行对照分析.10例患者进行了跟踪随访.结果 所有病例均为周围型病变,病灶位于左上叶4例,左下叶2例,右下肺4例.胸部增强薄扫CT表现为小片状毛玻璃阴影,直径最小0.5 cm,最大1.2 cm.病灶边界尚清,密度较均匀,纵隔窗显示不清,未见明显分叶、毛刺、空泡征及胸膜皱缩.所有病例均行手术治疗,两例开胸手术、8例胸腔镜手术.两例为病灶楔形切除,8例为肺叶切除.术后所有患者恢复顺利,未出现严重并发症.术后所有病例石蜡病理均为＂非典型腺瘤样增生＂.肉眼观察病灶剖面为圆盘状,白或灰白色,与周围肺组织分界较清楚,手触摸质地不硬,为增厚改变.显微镜下表现为局部肺泡上皮增生明显,肺泡间隔轻度增厚,局部纤维细胞增生,部分病例可见轻度核异型性.所有患者进行了定期随访,随访时间2个月～5年,目前10例患者均存活,无复发、转移情况发生,生活质量良好.结论 AAH通过高分辨率增强CT薄扫显示的影像特点和CT值直方图有助于提高术前诊断率,但最终确诊仍需组织学证据.手术仍是治疗AAH的可靠手段之一.Objective To analyze the characteristic of atypical adenomatous hyperplasia （AAH） in lungs though its computerized tomogaphy （CT） scan, pathology and surgical mode. Methods The investigators retrospectively evaluated 10 atypical adenomatous hyperplasias （AAH） that were histologically confirmed and that manifested pure ground glass opacity （GGO） on thin-section helical CT scans. There were 2 males and 8 females with a median age 54. 4 years old. All patients had the surgery. Their characteristic of CT scan and pathology were compared. All received a follow-up. Results In all cases,peripheral nodules were located at left upper lobe （n =4）, left lower lobe （n =2） and right lower lobe （n =4）. GGO at a diameter of 0.5 -1.2 cm was manifested on thin-section helical CT scans. The borderline of GGO was distinct and there was an equal density. Two of 10 cases underwent a wedge resection and 8 lobectomy. Postoperative patients recovered quickly without severe complications. Microscopically it manifested an apparent local pattern of alveolus epithelium hyperplasia in lungs. The alveolar interval had a slight increase. Local hyperplasia of fibrous cells was present with a slight degree of nucleus heteromorphism. The follow-up period was 2 months to 5 years. Ten patients with an excellent life quality survive without recurrence and metastasis. Conclusion The preoperative diagnostic rate of AAH is boosted by high-differentiation enhancement CT scan and CT number histograms. But a definite diagnosis still requires the histological evidence. Surgery is one of the most reliable therapy for AAH.

关 键 词：肺 腺瘤 诊断 

分 类 号：R686[医药卫生—骨科学]