儿童肺部病变215例临床病理学分析  

Pediatric lung lesions： a clinicopathological study of 215 cases

作　　者：牛会林 王凤华 刘威 王勇[2] 陈峥嵘 高秋 伊鹏 李丽萍 曾荣新 

机构地区：[1]广州市妇女儿童医疗中心病理科,510623 [2]广州市妇女儿童医疗中心儿童外科,510623 [3]广州市妇女儿童医疗中心儿童内科,510623

出　　处：《中华病理学杂志》2015年第9期648-652,共5页Chinese Journal of Pathology

摘　　要：目的探讨儿童肺部病变的临床病理特征。方法对215例肺部病变的临床表现、影像学、组织形态及免疫组织化学染色等进行分析并复习相关文献。结果215例肺部病变儿童年龄大小刚出生至13岁，平均年龄27．2个月，中位年龄18．0个月。男137例，女78例，男女比为1．76：1．00。〈1岁组肺先天性病变发病率高于≥1岁组，两组差异具有统计学意义（P=0．004）。215例肺部病变中获得性病变142例，先天性肺支气管发育异常相关病变73例。肺脓肿的发病率最高，见于86例患儿（40．0％），其中真菌性肺脓肿l例；其次为先天性肺气道畸形（CPAM）44例（20．5％），其中1型20例，2型18例，4型6例；肺隔离症25例（11．6％），叶内型14例，叶外型11例；叶外型肺隔离症中有2例合并CPAM2型；肺结核13例（6．0％）；肺气肿改变12例（5．6％）；间质性肺炎7例（3．2％）；肺出血6例（2．8％）；支气管源性囊肿4例（1．9％）；闭塞性毛细支气管炎2例（0．9％）；肺特发性含铁血黄素沉积症2例（0．9％）；肺非特异性改变1例；肿瘤性病变共13例（6．0％），其中原发性肿瘤共11例（5．1％），包括炎症性肌纤维母细胞肿瘤5例（2．3％）、胸膜肺母细胞瘤5例（I型1例，Ⅱ型2例，Ⅲ型2例）、黏液表皮样癌1例（0．5％）；转移性肿瘤共2例（0．9％），其中肝母细胞瘤及肾母细胞瘤转移各1例。结论儿童肺部病变以感染性病变为主；小于1岁婴幼儿则以先天性肺支气管发育异常为主；恶性病变发病率低，但须注意与良性病变相鉴别。Objective To investigate clinical and pathological features of lung lesions in children. Methods Clinical manifestations, radiologic imaging, histopathological features and immunohistochemical results were analyzed in 215 cases of lung lesions in children. Results A total of 215 cases of lung lesions in children aged 0 day to 13 years （average age of 27.2 months and the median age of 18.0 months ） were selected, including 137 male and 78 female patients with a male to female ratio of 1.76： 1.00. The incidence of congenital lung disease was higher in patients of less than 1 year old than those of over 1 year old age, and the difference of the two groups was statistically significant （ P = 0. 004 ） . 142 cases had acquired lung diseases, and 73 cases had congenital bronchopulmonary dysplasia. Lung abscess was the most common lesion seen in 86 cases （40. 0% ） , including 1 case of fungal abscess. Congenital pulmonary airway malformation （CPAM） was the second most common, seen in 44 patients （20. 5% ）, including 20 cases of type 1, 18 cases of type 2 and 6 cases of type 4 CPAM. Pulmonary sequestration was found in 25 cases （ll. 6% ） including 14 cases of intralobar type and 11 cases of extralobar type. Two cases of extralobar pulmonary sequestration showed simultaneous CPAM2 type 2 lesion. Other lesions included tuberculosis （ 13 cases, 6. 0% ）, emphysema （ 12 cases, 5.6% ） , interstitial pneumonia （7 cases, 3.2% ）, pulmonary hemorrhage （6 cases, 2. 8% ） , bronchogenic cyst （4 cases, 1.9% ） , bronchiolitis obliterans （2 cases, 0. 9% ） , idiopathic pulmonary hemosiderin deposition disease （ 2 cases, 0. 9% ） and 1 cases of lung non- specific changes. 13 cases of neoplastic lesions （6. 0% ） were found, of which 11 cases were primary tumors （5.1% ）, including inflammatory myofibroblastic tumor in 5 patients （2. 3% ）, pleuropulmonary blastoma in 5 cases （ 1 case of type Ⅰ, 2 type Ⅱ and 2 type Ⅲ ） and 1 case of mucoepidermoid carcinoma （0. 5% ）

关 键 词：儿童 肺疾病 肺脓肿 呼吸系统畸形 

分 类 号：R725.6[医药卫生—儿科]