本文關(guān)鍵詞： 肺原發(fā)性粘液腺癌 臨床特征 預(yù)后 影響因素　出處：《大連醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:分析肺原發(fā)性粘液腺癌(Primary Pulmonary Mucinous(Colloid)Adenocarcinoma PPMA)的臨床表現(xiàn)、影像學(xué)特征、病理特點(diǎn)、治療方式及其預(yù)后的重要影響因素。方法:回顧性分析大連醫(yī)科大學(xué)附屬第一醫(yī)院胸外科2011年1月至2016年1月手術(shù)的并經(jīng)術(shù)后病理證實(shí)且隨訪資料完整的79例PPMA患者資料,記錄了基本一般情況主要包括性別、年齡、臨床癥狀、吸煙情況、腫瘤家族史、CEA、cyfra21-1、FVC,FVC%,FEV1,MVV,TNM分期,術(shù)前并發(fā)癥情況等,CT表現(xiàn)包括腫瘤位置、腫瘤最大徑、胸膜侵犯情況,淋巴結(jié)轉(zhuǎn)移情況、脈管侵襲情況、特征性表現(xiàn)(分葉征、邊緣毛刺征、厚壁偏心空洞、胸膜凹陷征、血管進(jìn)入征、支氣管充氣征或空泡征),治療情況包括手術(shù)方式(微創(chuàng)或者開放)、手術(shù)時(shí)間,胸腔閉式引流管留置時(shí)間,術(shù)中失血量、住院天數(shù)、術(shù)后并發(fā)癥,術(shù)后輔助治療方案等因素;以Kaplan-Meier法計(jì)算生存率、Log-rank進(jìn)行生存率顯著性檢驗(yàn)進(jìn)行單因素分析、Cox比例回歸風(fēng)險(xiǎn)模型進(jìn)行多因素分析,進(jìn)而評(píng)價(jià)各因素對(duì)預(yù)后的影響。結(jié)果:79例肺原發(fā)性粘液腺癌,男性35例,女性34例,占我科同期經(jīng)手術(shù)后證實(shí)肺癌的2.16%,其中單純性的浸潤性粘液腺癌39例(49.4%),微浸潤粘液腺癌2例(2.5%),混合型粘液腺癌37例(46.8%),中央型肺癌3例,周圍型肺癌76例,平均發(fā)病年齡為(62.04±8.82)歲,其中52例(65.8%)是由于體檢時(shí)發(fā)現(xiàn)肺部陰影來就診,36例(45.6%)至少出現(xiàn)一種臨床癥狀,最常出現(xiàn)的臨床癥狀是咳嗽、咳痰,胸悶,其中15例出現(xiàn)痰中帶血,3例有胸腔積液,1例出現(xiàn)咳血;吸煙者15例,均為男性,癌胚抗原cea升高者16例,細(xì)胞角蛋白19片段cyfra21-1升高者39例,fvc平均值(2.87±0.76)l,fvc%平均值(84.80±14.62)%。fev1平均值(2.43±0.69)l。mvv平均值(94.19±34.19)l/min,tnm分期:其中i期59例(74.68%),ii期12例(15.19%),iii期7例(8.86%),iv期1例(1.3%)。腫瘤生長部位:其中左肺上葉10例(12.65%),左肺下葉22例(27.85%),右肺上葉13例(16.46%),右肺中葉5例(6.32%),右肺下葉27例(34.18%),腫瘤侵及右肺中下葉2例(2.5%)。病灶最大徑8cm,最小徑0.4cm。ct表現(xiàn)可見血管進(jìn)入征70例(88.6%),分葉征42例(53.16%),周圍可見毛刺征56例(70.89%),腫瘤內(nèi)部可見支氣管充氣征30例(38.0%),空洞征12例(15.19%),周圍可見緊鄰胸膜牽拉征52例(65.82%)。79例患者全部經(jīng)過手術(shù)治療,術(shù)后病理證實(shí)淋巴結(jié)轉(zhuǎn)移者4例,胸膜侵犯者52例,脈管侵襲者10例,其中其中微創(chuàng)胸腔鏡手術(shù)63(79.75%),開放手術(shù)17例(21.52%)。手術(shù)時(shí)間平均值(2.4±1.06)h,術(shù)中出血量平均為(36.01±34.65)ml,引路管引流平均為(3.90±2.05)d,住院天數(shù)平均值(11.10±4.41)d,術(shù)后25例行手術(shù)聯(lián)合術(shù)后化療,5例行手術(shù)聯(lián)合術(shù)后放化療和免疫治療。其中1例患者術(shù)后6個(gè)月出現(xiàn)頭顱,全身骨(腰椎)轉(zhuǎn)移,于術(shù)后10個(gè)月死亡,其中1例術(shù)后聯(lián)合4期化療1年后出現(xiàn)雙肺、全身骨轉(zhuǎn)移,于術(shù)后44個(gè)月死亡,其中1例術(shù)后聯(lián)合化療后25個(gè)月出現(xiàn)頭顱、胸部淋巴結(jié)轉(zhuǎn)移,現(xiàn)接受放化療,仍然健在。55例在隨訪結(jié)束期間,繼續(xù)存活并且復(fù)查證實(shí)無復(fù)發(fā)或轉(zhuǎn)移,生活狀態(tài)良好。全部患者的1年、3年、5年生存率分別為94%、74%、71%,中位生存期為60個(gè)月。單因素分析顯示:確診時(shí)臨床tnm分期(p=0.002)、支氣管充氣征(p=0.019)、手術(shù)方式(p=0.017)是影響預(yù)后的重要因素,其他因素:性別(p=0.075)、年齡(p=0.349)、臨床癥狀(p=0.408)、吸煙情況(p=0.123)、cea(p=0.082)、cyfra21-1(p=0.559)、cea和cyfra21-1聯(lián)合(p=0.707)、fvc(p=0.594),fvc%(p=0.744),fev1(p=0.834),mvv(p=0.243),術(shù)前并發(fā)癥情況(p=0.586),ct表現(xiàn)包括腫瘤位置(p=0.077)、腫瘤最大徑(p=0.122)、胸膜侵犯情況(p=0.682),淋巴結(jié)轉(zhuǎn)移情況(p=0.114)、脈管侵襲情況(p=0.624)、分葉征(p=0.210)、邊緣毛刺征(p=0.931)、厚壁偏心空洞(p=0.193)、胸膜凹陷征(p=0.812)、血管進(jìn)入征(p=0.970)、手術(shù)時(shí)間(p=0.251),胸腔閉式引流管留置時(shí)間(P=0.496),術(shù)中失血量(P=0.740)、住院天數(shù)(P=0.139)、術(shù)后并發(fā)癥(P=0.797),術(shù)后輔助治療方案(P=0.407)均不是影響預(yù)后的因素;Cox回歸多因素分析顯示:無影響預(yù)后的獨(dú)立因素。結(jié)論:1.肺原發(fā)性粘液腺癌臨床表現(xiàn)無明顯特異性。2.影像學(xué)主要表現(xiàn)為:周圍型為主,實(shí)性結(jié)節(jié)居多,好發(fā)于雙肺下葉,支氣管充氣征是特征性影像學(xué)表現(xiàn)。3.TNM分期、支氣管充氣征、手術(shù)方式是影像預(yù)后的重要因素,無明顯獨(dú)立影響因素
[Abstract]:Objective: to analyze the primary lung mucinous adenocarcinoma (Primary Pulmonary Mucinous (Colloid) Adenocarcinoma PPMA) of the clinical manifestations, imaging features, pathological characteristics, important factors influencing the way of treatment and prognosis. Methods: a retrospective analysis from January 2011 to January 2016 in Department of thoracic surgery surgery the First Affiliated Hospital of Dalian Medical University, confirmed by pathology and 79 cases the data of PPMA patients with complete follow-up data, records the basic general situation including gender, age, clinical symptoms, smoking status, family history, tumor CEA, CYFRA21-1, FVC, FVC%, FEV1, MVV, TNM staging, preoperative complications, CT findings including the location of the tumor, the maximum tumor diameter, pleural invasion. Lymph node metastasis, vascular invasion, features (lobulation, edges, thick wall eccentric hole, pleural indentation, vascular access sign, air bronchogram or vacuole sign), treatment Treatment including surgery (minimally invasive or open), operation time, closed thoracic drainage tube indwelling time, intraoperative blood loss, hospitalization time, postoperative complications, postoperative adjuvant treatment and other factors were calculated by Kaplan-Meier method; the survival rate, survival rate of Log-rank was significant test was used for univariate analysis, the proportion of Cox regression model for multivariate analysis, and evaluate the effect of various factors on the prognosis. Results: 79 cases of primary lung mucinous adenocarcinoma, 35 males, 34 females, 2.16% confirmed by surgical lung cancer in our department during the same period, the single pure invasive mucinous adenocarcinoma in 39 cases (49.4%) micro invasive mucinous adenocarcinoma, 2 cases (2.5%), 37 cases of mixed type mucinous adenocarcinoma (46.8%), 3 cases of central lung cancer, 76 cases of peripheral lung cancer, the average age was (62.04 + 8.82) years old, of which 52 cases (65.8%) is due to physical examination found that 36 cases were pulmonary shadows, (45.6%) at least 鐜頒竴縐嶄復(fù)搴婄棁鐘，

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