孤立性肺结节良恶性诊断的临床影响因素  

Differential Diagnosis between Benign and Malignant Solitary Pulmonary Nodules

作　　者：江华[1] 彭忠民[1] 高金萍[1] 王晓航[1] 刘颖[1] 王功朝[1] 

机构地区：[1]山东大学附属省立医院胸外科,济南250021

出　　处：《中国胸心血管外科临床杂志》2014年第6期788-792,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：山东省卫生和计划生育委员会面上项目(2013WS0273)~~

摘　　要：目的探讨孤立性肺结节（solitary pulmonary nodule，SPN）良恶性诊断的相关临床影响因素及外科治疗策略。方法回顾性分析2010年11月至2012年3月在山东大学附属省立医院行手术治疗的151例SPN患者的临床及病理资料，其中男89例、女62例，年龄30～80（57．99±0．86）岁，比较不同临床因素对恶性率影响的差异。结果良性SPN29例，恶性122例。恶性SPN IA期58例，IB期30例，ⅡA期7例，ⅢA期25例，Ⅳ期2例。恶性SPN的平均直径大于良性（2．03cm1VS．1．77cm，P=0．039），直径大于2cm者的恶性率高于2cm以下者（90．3％VS．74．2％，P=0．013），恶性患者的平均年龄大于良性患者（60．39岁VS．47．90岁，P〈0．01），年龄45岁以上患者的恶性率高于〈45岁患者（86．4％VS．38．9％，P〈0．01）。不同性别、有无临床症状、有无吸烟史、吸烟指数≤400支／年和〉400支／年、不同部位的恶性率差异无统计学意义。结论SPN的良恶性诊断应当综合患者的病史、年龄、结节直径、形态、动态变化进行判断，性别、有无临床症状、吸烟与否、吸烟指数及位置作为诊断参考因素的意义不大。Objective To investigate differential diagnosis between benign and malignant of solitary pulmonary nodules （SPN） and surgical strategies. Methods We retrospectively analyzed clinical and pathological data of 151 SPN patients who underwent surgical resection in Provincial Hospital Affiliated to Shandong University between November 2010 and March 2012. There were 89 male and 62 female patients with their age of 30-80 （57.99± O. 86 ）years. Differential factors between benign and malignant SPN were analyzed. Results There were 29 patients with benign SPN and 122 patients with malignant SPN. Among the 122 malignant SPN patients, there were 58 patients in stage I A, 3O patients in stageⅠB, 7 patients in stage ⅡA, 25 patients in stage ⅢA and 2 patients in stage Ⅳ. Mean diameter of malignant SPN was significantly larger than that of benign SPN （2.03 cm vs 1.77 cm, P=0.039）. Malignant rate of SPN larger than 2 cm was significantly higher than that of SPN smaller than 2 cm （90.3% vs. 74.2%, P=0.013）. Patients with malignant SPN was significantly older than patients with benign SPN （60.39 years vs. 47.90 years, P 〈 0.01 ）. Malignant rate of patients over 45 years was significantly higher than that of patients younger than 45 years （86.4% vs. 38.9%, P 〈 0.01 ） .There was no statistical difference in malignant rate between male and female, with and without clinical symptoms,smoking and nonsmo- king, smoking index ≤400 and 〉 400 and among different lobes. Conclusions Differential factors of SPN include patients＇ medical history, age, diameter and shape of nodules, which should be considered comprehensively and dynamically. Gender, clinical symptoms, smoking history, smoking index and SPN location are not helpful for differential diagnosis of SPN.

关 键 词：孤立性肺结节 诊断 外科治疗 

分 类 号：R655.3[医药卫生—外科学]