肺癌性淋巴管炎16例临床分析及治疗体会  

Clinical analysis and treatment experience of 16 cases of pulmonary lymphangitic carcinomatosis

作　　者：许瞻 朱阿楠 邵国丰[2] 

机构地区：[1]浙江省余姚市中医医院内科,浙江余姚315400 [2]宁波市医疗中心李惠利医院心胸外科,浙江宁波315000

出　　处：《中国现代医生》2015年第23期34-37,共4页China Modern Doctor

基　　金：浙江省自然科学基金资助项目(LY12H16002)

摘　　要：目的探讨并总结肺内癌性淋巴管炎（pulmonary lymphangitic carcinomatosis,PLC）的临床特征,初步探讨大剂量糖皮质激素（甲强龙）对PLC的治疗作用。方法分析2010~2014年我院16例肺癌性淋巴管炎的临床特征,将16例患者随机分为对照组和治疗组,对照组予常规对症治疗治疗组在对照组的基础上给予大剂量的甲强龙静脉注射（80 mg q8h）,1周后判定疗效。结果本组PLC原发肿瘤以腺癌居多,影像学表现：除可见从肺门向肺野呈放射状、条索状不均一阴影,部分条索可达胸膜并见小结节或肺野呈毛玻璃状改变;纵隔、肺门淋巴结肿大（56.25%）外,胸腔积液（75.00%）所占比例较大。治疗组在给予吸氧等一般治疗的基础上给予大剂量激素治疗后,呼吸困难、活动能力、氧分压较对照组有所改善（P〈0.05）;但肺弥散功能无改善,且二氧化碳分压无明显降低（P〉0.05）。结论 PLC常发生于肺癌、乳腺癌、大肠癌、胃癌等肿瘤的肺内转移。当患者出现上述肺间质病变,呼吸道症状经气道解痉药治疗无效,病情急进性发展时,应高度怀疑PLC,可尝试使用大剂量激素缓解临床症状。Objective To evaluate and summarize the clinical features of pulmonary lymphangitic carcinomatosis （PLC） and discuss the treatment effects of large dose corticosteroids （methylprednisolone） on PLC. Methods The clinical fea- tures of 16 patients with PLC treated in our hospital from 2010 to 2014 were analyzed. The 16 patients were randomly divided into the control group and the treatment group. The control group Was treated with conventional symptomatic treatment. The treatment group was given intravenous injection of large dose methylprednisolone（80 mg q8h） on the ba- sis of the control group. The efficacy was evaluated after 1 week. Results All the PLC primary tumors was mainly ade- nocarcinoma and the imaging manifestations were as follows： In addition to the visible radial-pattern and cord-like shadow ranging from lung hilum to lung filed, some cords could reach pleura and the nodules were observed; or the lung filed presented frosted glass-like changes; in addition to lymphadenectasis（56.25%） of mediastinum and lung hilus, pleural effusion （75.00%） accounted for a larger proportion. In treatment group, large dose hormone was given on the basis of ordinary treatment such as oxygen uptake, after which the breathing difficulty, capacity of action and oxygen partial pressure improved than the control group（P〈0.05）; but pulmonary diffusion function did not improve and carbon dioxide partial pressure did not reduce significantly（P〉0.05）. Conclusion PLC often occurs in the lung metastasis of lung cancer, breast Cancer, colorectal cancer and gastric cancer. When patients have the above interstitial lung disease, airway antispasmodic treatment is ineffective on respiratory tract symptoms, and the disease develops rapidly, PLC is highly suspicious. Large dose hormone should be tried to relieve clinical symptoms.

关 键 词：肿瘤 肺内癌性淋巴管炎/继发性 临床特征 

分 类 号：R734.2[医药卫生—肿瘤]