以多发空洞为首发表现的肺腺癌临床特征  

Clinical Features of Lung Adenocarcinoma with Multiple Moles as the First Manifestation

作　　者：武静[1] 焦鹏飞[1] 王志刚[1] 褚丹[1] 李雅萌 张庆宪[1] WU Jing;JIAO Peng-fei;WANG Zhi-gang;CHU Dan;LI Ya-meng;ZHANG Qing-xian(Department of Respiratory,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院呼吸内科,河南郑州450052

出　　处：《河南医学研究》2020年第27期5008-5011,共4页Henan Medical Research

摘　　要：目的探讨以多发空洞为首发表现的肺腺癌的临床特征,提高临床诊断率。方法搜集郑州大学第一附属医院2013年1月至2019年5月收治的以多发空洞为首发表现的32例原发性肺腺癌患者。回顾性分析患者的临床表现、实验室检查、胸部CT表现、误诊情况、治疗过程及转归。结果32例患者中男15例,女17例,年龄26~83岁,平均(61.0±8.2)岁。咳嗽26例,咳痰17例,胸闷10例,胸痛5例,发热4例,痰中带血4例。19例行血肿瘤标志物检测,血癌胚抗原(CEA)增高12例;CEA正常,肿瘤相关抗原199(CA199)、细胞角蛋白19片段(CYFRA21-1)同时增高5例。双肺多发小环形空洞15例(46.88%),洞壁光滑,呈随机分布;双肺多发厚壁和(或)薄壁空洞11例(34.38%),厚壁空洞内多见粗大软组织分隔,薄壁空洞内多见线样分隔;空洞伴周围磨玻璃影或大片实变影6例(18.75%)。26例(81.25%)患者早期误诊为肺部良性病变,后经肺穿刺或支气管镜活检病理确诊。结论以多发空洞为首发表现的肺腺癌临床少见,其临床表现及肺部影像学表现与肺部炎症病变难以区分,易误诊为肺炎,尽早行CT引导下肺穿刺或支气管镜活检病理可提高诊断率。Objective To investigate the clinical features of lung adenocarcinoma with multiple cavities as the first manifestation and to improve the clinical diagnosis rate.Methods Patients with primary lung adenocarcinoma who were admitted to the First Affiliated Hospital of Zhengzhou University from January 2013 to May 2019 with multiple cavities in the lungs were collected.The clinical manifestations,laboratory tests,chest CT findings,misdiagnosis,treatment progress and outcomes of the patients were retrospectively analyzed.Results Thirty-two patients were 15 males and 17 females,aged 26-83 years,with an average(61.0±8.2)years.There were 26 cases of cough,17 cases of cough,10 cases of chest tightness,5 cases of chest pain,4 cases of fever,and 4 cases of blood in the sputum.The blood carcinoembryonic antigen(CEA)increased in 12 cases,and CEA was normal,and cancer antigen 199(CA199)and cytokeratin 19 fragment(CYFRA21-1)were increased in 5 cases at the same time in 19 cases examined by blood tumor markers.Fifteen cases(46.88%)of multiple small circular cavities were found in both lungs,with smooth walls and random distribution.Eleven cases(34.38%)of thick walls and/or thin-walled cavities were found in both lungs,and thick soft tissues were more common in thick-walled cavities,and line-like patterns were more common in thin-walled cavities.Six cases(18.75%)with hollow ground glass around or large areas of consolidation.Twenty-six patients(81.25%)were misdiagnosed as pneumonia at an early stage,and then confirmed by pathology or bronchoscopy.Conclusion Lung adenocarcinoma with multiple cavities as the first manifestation is rare in clinical practice.Its clinical manifestations and pulmonary imaging findings are distinguished from pulmonary inflammatory lesions.It is easily misdiagnosed as pneumonia.CT-guided pulmonary puncture or bronchoscopy biopsy can be performed as soon as possible in order to improve the diagnostic rate.

关 键 词：多发空洞 肺腺癌 诊断 预后 

分 类 号：R734.2[医药卫生—肿瘤]