原发性肺黏液腺癌肿块型与肺炎型的诊断及恶性程度对比分析  

Diagnosis and malignant analysis of mass versus pneumonia type of primary pulmonary mucinous adenocarcinoma

作　　者：冯义辉 朱晓雷 方韶韩 张潇文 李宁 耿国军[1] FENG Yihui;ZHU Xiaolei;FANG Shaohan;ZHANG Xiaowen;LI Ning;GENG Guojun(Fujian Medical University,Fuzhou,350122,P.R.China;Department of Thoracic Surgery,The First Affiliated Hospital of Xiamen University,Xiamen,360000,Fujian,P.R.China)

机构地区：[1]福建医科大学,福州350122 [2]厦门大学附属第一医院胸外科,福建厦门360000

出　　处：《中国胸心血管外科临床杂志》2025年第3期360-365,共6页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的探讨原发性肺黏液腺癌(primary pulmonary mucinous adenocarcinoma,PPMA)肿块型与肺炎型之间的关系及恶性程度区别,同时分析临床表现、CT特征在该疾病诊断中的作用。方法回顾性分析2011年5月—2022年3月厦门大学附属第一医院收治的PPMA患者的临床资料。根据CT特征将患者分为肿块型组及肺炎型组。分析比较两组的临床表现、CT特征及恶性程度。结果共纳入57例PPMA患者,其中男17例、女40例,平均年龄(53.82±10.65)岁,有类反晕征患者共28例(49%)。肿块型组42例,肺炎型组15例。PPMA多发生于双下肺,临床表现以咳嗽、咳白色黏液样痰为主。两组肿瘤最大径(P<0.001)、边界情况(P<0.001)、胸膜凹陷征(P=0.019)差异有统计学意义。两组Ki-67指数差异无统计学意义(P>0.05)。结论两种类型的PPMA在恶性程度上无显著差异,结合其临床表现及影像学特征差异,支持肺炎型只是肿块型的病情进展表现。CT上可表现多样,其中类反晕征有望成为重要的影像学特征,联合实性成分占比高、胸膜凹陷征及空泡征等特征,能对PPMA诊断起到重要辅助作用。Objective To investigate the relationship between primary pulmonary mucinous adenocarcinoma(PPMA)mass type and pneumonia type and their difference in malignant degree,and to analyze the role of clinical manifestations and CT features in the diagnosis of this disease.Methods The clinical data of PPMA patients admitted in the First Affiliated Hospital of Xiamen University from May 2011 to March 2022 were retrospectively analyzed.According to CT features,they were divided into a mass type group and a pneumonia type group.The clinical manifestations,CT features and the degree of malignancy between the two groups were analyzed and compared.Results A total of 57 PPMA patients were enrolled.There were 17 males and 40 females,with an average age of(53.82±10.65)years,and 28(49%)patients had reversed hato-like sign.There were 42 patients in the mass type group and 15 patients in the pneumonia type group.PPMA often occurs in both lower lungs,with clinical manifestations mainly of coughing and expectorating white mucoid sputum.There were statistical differences between the two groups in the maximum diameter of tumor(P<0.001),boundary condition(P<0.001)and pleural indentation sign(P=0.019).There was no statistical difference between the two groups in Ki-67 index(P>0.05).Conclusion There is no statistical difference in the degree of malignancy between the two types of PPMA.Considering their clinical manifestations and differences in imaging features,it is supported that the pneumonia type is just a progression of the mass type.CT can present various manifestations,among which the reversed hato-like sign is expected to become an important imaging feature.Combined with a high proportion of solid components,pleural indentation sign,and vacuole sign,reversed hato-like sign can play a significant role in the diagnosis of PPMA.

关 键 词：原发性肺黏液腺癌 肿块型 肺炎型 KI-67指数 影像学特征 类反晕征 

分 类 号：R73[医药卫生—肿瘤]