肺炎型肺腺癌29例临床分析  

Clinical analysis of pneumonic-type adenocarcinoma

作　　者：丁群力[1] 王碧炯[1] 张巧丽[1] 邓在春[1] 

机构地区：[1]浙江省宁波大学医学院附属医院呼吸内科,315020

出　　处：《中华全科医学》2014年第12期1908-1910,共3页Chinese Journal of General Practice

基　　金：浙江省宁波大学科研基金资助项目(XYY11003)

摘　　要：目的分析肺炎型肺腺癌的临床特征,提高对肺炎型肺腺癌的认识。方法收集宁波大学医学院附属医院经病理证实的29例肺炎型肺癌病例,回顾性分析其临床特征、影像学特点、诊断、治疗及预后。结果 29例PADC患者中男性16例,女性13例,平均年龄58.7岁。最常见症状为咳嗽（16/29）、咳痰（14/29）,有6例表现为支气管粘液溢,绝大多数无异常体征;影像学表现55.2%（n=16）表现为双肺病变,有82.8%（n=24）可见支气管充气征,3例在原发病灶周边可见卫星灶;支气管镜检查管腔内均未发现新生物生长,其中21例（72.4%）经支气管镜肺组织活检（钳取2～4块肺组织,15/18）、肺泡灌洗液找脱落细胞（10/19）得到病理诊断;肺叶切除术预后显著高于全肺切除、化疗、分子靶向及保守治疗。结论肺炎型肺癌的临床表现缺乏特异性,支气管粘液溢可能可作为诊断线索,影像学表现与肺炎难以鉴别,肺叶切除术是肺炎型肺癌治疗最有效方式。Objective To investigate the clinical features of pneumonic-type adenocarcinoma（ P-ADC）, and to further reveal the characteristics of this disease. Methods The clinical data of 29 cases of P-ADC proven pathologically were retrospectively reviewed, the clinical symptoms, imaging features, diagnosis, treatment and prognosis were analyzed. Results Sixteen of the 29 patients were male, others were female ; the mean age at the diagnosis was 58.7 years. The common symptoms were cough （16/29）, sputum（ 14/29 ） ;6 patients showed bronchorrhea;most cases were without abnor- mal signs. 55.2% （ n = 16 ） of them were with the bilateral lesions by chest radiograph and CT ; 82.8 % （ n = 24 ） of them were with an air bronchogram by CT;three patients had a satellite tumor within the lobe containing the primary tumor. None cases were found with intraluminal masses by bronchoscopy. 21 cases（72.4% ） received lung biopsy,and the posi- tive results of transbronchial biopsy and BAL were 83.3% and 52.6% ,respectively. The outcome of patients received lo- bectomy or bilobectomy was significantly better than that of patients with pneumonectomy, chemotherapy, molecular targe- ted therapy or best supportive care. Conclusion The clinical manifestations of P-ADC are nonspecific, bronchorrhea may provide clues for diagnosis, imaging findings is not significance in the identification between P-ADC and pneumonia, The pulmonary lobectomy remains the most effective treatment in P-ADC, especially when lobectomy is feasible.

关 键 词：肺炎型肺腺癌 诊断 影像学表现 

分 类 号：R734.2[医药卫生—肿瘤]