成人支氣管源性囊腫臨床分析
發(fā)布時(shí)間：2018-10-10 18:20
【摘要】：背景 支氣管源性肺囊腫是先天性肺囊性疾病中最常見的類型,約占先天性肺囊性疾病的50%。其發(fā)病機(jī)制目前尚不明確,通常認(rèn)為是胚胎期原腸發(fā)出的胚芽部分發(fā)育障礙,其遠(yuǎn)端的原始支氣管組織與近端組織脫離,形成盲管,腔內(nèi)分泌物潴留所致,一般與正常支氣管不相通。目前,國內(nèi)外對支氣管源性囊腫的研究主要以病例報(bào)道為主。支氣管源性囊腫的臨床表現(xiàn)無特異性,有時(shí)影像學(xué)表現(xiàn)也無明顯特征,容易誤診為其他疾病,如肺癌、肺結(jié)核、胸腺瘤、神經(jīng)源性腫瘤等。該病的治療方法首選手術(shù)切除病灶,手術(shù)方式包括胸廓切開術(shù)和胸腔鏡術(shù)。 我們總結(jié)回顧了經(jīng)手術(shù)病理確診的24例成人支氣管源性囊腫的完整資料,從臨床表現(xiàn)、影像學(xué)特點(diǎn)、術(shù)前診斷、病理特點(diǎn)、治療及預(yù)后等方面探討該病,以提高對該病的診治水平。 目的 探討成人支氣管源性囊腫的臨床表現(xiàn)、影像學(xué)特點(diǎn)、術(shù)前診斷、病理學(xué)特點(diǎn)及治療和預(yù)后,重點(diǎn)總結(jié)分析影像學(xué)特點(diǎn)及誤診原因,吸取經(jīng)驗(yàn)教訓(xùn),以期提高對支氣管源性囊腫的診治水平。 材料與方法 回顧性分析浙江大學(xué)醫(yī)學(xué)院附屬第一醫(yī)院2009年7月至2014年4月經(jīng)手術(shù)證實(shí)病理確診的24例成人患者胸腔內(nèi)支氣管源性囊腫的完整資料,總結(jié)分析患者的臨床表現(xiàn)、影像學(xué)特點(diǎn)、術(shù)前診斷、病理學(xué)特點(diǎn)、治療及預(yù)后。 結(jié)果 其中男性10例,女性14例；最小年齡24歲,最大年齡76歲,平均年齡47.3歲。臨床癥狀包括：咳嗽咳痰9例,胸悶氣急5例,胸痛4例,發(fā)熱4例,無癥狀者6例。根據(jù)影像學(xué)檢查將病灶分為肺內(nèi)型和縱膈型,其中肺內(nèi)型9例,縱隔型15例。典型CT特征為密度均一的圓形、類圓形水樣密度或軟組織影或薄壁囊腔,界清,邊緣較光整,增強(qiáng)后不強(qiáng)化或輕度強(qiáng)化。當(dāng)囊腫并發(fā)感染時(shí)囊腔內(nèi)可見氣液平面。典型MRI特征為T1WI圖像上呈均勻低信號(hào),而T2WI圖像上呈均勻高信號(hào),增強(qiáng)后無明顯強(qiáng)化。術(shù)前僅7例診斷為支氣管源性囊腫,6例診斷為肺癌,3例診斷為神經(jīng)源性腫瘤,2例診斷為胸腺瘤,1例診斷為肺結(jié)核,1例診斷為肺膿腫,1例診斷為肺大泡。病理特點(diǎn)：鏡下見假覆層纖毛柱狀上皮、腺體、軟骨、彈力纖維及少量平滑肌,部分可見中性粒細(xì)胞、炎性細(xì)胞浸潤。14例行胸廓切開術(shù),10例經(jīng)胸腔鏡囊腫切除術(shù)。術(shù)后隨訪5個(gè)月至62個(gè)月,平均36.6個(gè)月,均未出現(xiàn)囊腫復(fù)發(fā)。 結(jié)論 成人支氣管源性囊腫臨床表現(xiàn)主要為咳嗽咳痰、胸悶氣急,胸部CT及MRI對支氣管源性囊腫具有較大診斷價(jià)值。該病缺乏特異的臨床表現(xiàn)及影像學(xué)檢查,有時(shí)容易誤診為其他疾病。手術(shù)切除是明確診斷和治療支氣管源性囊腫最佳方案。
[Abstract]:Background Bronchogenic pulmonary cyst is the most common type of congenital pulmonary cystic disease, accounting for about 50% of congenital pulmonary cystic disease. At present, the pathogenesis of the disease is still unclear, and it is generally considered to be partly dysplasia of the embryo germ produced by the primary intestine, and the distal primary bronchial tissue is separated from the proximal tissue, resulting in the formation of a blind tube and retention of secretions in the lumen. Generally speaking, it does not communicate with the normal bronchus. At present, cases of bronchial cysts are mainly reported at home and abroad. The clinical manifestations of bronchogenic cysts are not specific, and sometimes the imaging findings are not obvious. They are easily misdiagnosed as other diseases, such as lung cancer, tuberculosis, thymoma, neurogenic tumor and so on. Surgical resection is the preferred treatment for the disease, including thoracotomy and thoracoscopy. We reviewed the complete data of 24 cases of adult bronchogenic cysts confirmed by operation and pathology. We discussed the disease from clinical manifestations, imaging features, preoperative diagnosis, pathological features, treatment and prognosis. In order to improve the diagnosis and treatment of the disease. Objective to investigate the clinical manifestations, imaging features, preoperative diagnosis, pathological features, treatment and prognosis of adult bronchogenic cysts, and to summarize and analyze the imaging features and the causes of misdiagnosis, and to draw lessons from the experience. In order to improve the diagnosis and treatment of bronchogenic cysts. Materials and methods the complete data of 24 adult patients with intrathoracic bronchogenic cysts confirmed by surgery from July 2009 to April 2014 were retrospectively analyzed in the first affiliated Hospital of Zhejiang University Medical College. The clinical manifestations, imaging features, preoperative diagnosis, pathological features, treatment and prognosis of the patients were summarized and analyzed. Results there were 10 males and 14 females with the minimum age of 24 years and the maximum age of 76 years with an average age of 47.3 years. The clinical symptoms included cough and expectoration in 9 cases, chest tightness in 5 cases, chest pain in 4 cases, fever in 4 cases and asymptomatic in 6 cases. According to the imaging examination, the lesions were divided into intrapulmonary type and mediastinal type, including 9 cases of intrapulmonary type and 15 cases of mediastinal type. Typical CT is characterized by a uniform circular density, circular water density or soft tissue shadow or thin-walled cystic cavity, with clear boundary, relatively smooth edge, no enhancement or slight enhancement after enhancement. When the cyst is complicated with infection, the gas-liquid level can be seen in the cyst cavity. The typical features of MRI are homogeneous low signal on T1WI image and homogeneous high signal on T2WI image, but no obvious enhancement after enhancement. Preoperative diagnosis included bronchial cyst in 7 cases, lung cancer in 6 cases, neurogenic tumor in 3 cases, thymoma in 2 cases, pulmonary tuberculosis in 1 case, pulmonary abscess in 1 case and pulmonary bulla in 1 case. Pathological features: pseudociliary columnar epithelium, glandular body, cartilage, elastic fiber and a small amount of smooth muscle, neutrophil and inflammatory cell infiltration were observed under microscope. 14 cases underwent thoracotomy and 10 cases underwent thoracoscopic cysts resection. All the patients were followed up from 5 months to 62 months with an average of 36. 6 months. No recurrence of cysts occurred. Conclusion the clinical manifestations of bronchiogenic cysts in adults are mainly cough and sputum, chest tightness and shortness of breath. Chest CT and MRI are of great value in the diagnosis of bronchogenic cysts. The disease lacks specific clinical manifestations and imaging findings, and is sometimes misdiagnosed as other diseases. Surgical resection is the best method for the diagnosis and treatment of bronchial cysts.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R655.3
本文編號(hào)：2262778
[Abstract]:Background Bronchogenic pulmonary cyst is the most common type of congenital pulmonary cystic disease, accounting for about 50% of congenital pulmonary cystic disease. At present, the pathogenesis of the disease is still unclear, and it is generally considered to be partly dysplasia of the embryo germ produced by the primary intestine, and the distal primary bronchial tissue is separated from the proximal tissue, resulting in the formation of a blind tube and retention of secretions in the lumen. Generally speaking, it does not communicate with the normal bronchus. At present, cases of bronchial cysts are mainly reported at home and abroad. The clinical manifestations of bronchogenic cysts are not specific, and sometimes the imaging findings are not obvious. They are easily misdiagnosed as other diseases, such as lung cancer, tuberculosis, thymoma, neurogenic tumor and so on. Surgical resection is the preferred treatment for the disease, including thoracotomy and thoracoscopy. We reviewed the complete data of 24 cases of adult bronchogenic cysts confirmed by operation and pathology. We discussed the disease from clinical manifestations, imaging features, preoperative diagnosis, pathological features, treatment and prognosis. In order to improve the diagnosis and treatment of the disease. Objective to investigate the clinical manifestations, imaging features, preoperative diagnosis, pathological features, treatment and prognosis of adult bronchogenic cysts, and to summarize and analyze the imaging features and the causes of misdiagnosis, and to draw lessons from the experience. In order to improve the diagnosis and treatment of bronchogenic cysts. Materials and methods the complete data of 24 adult patients with intrathoracic bronchogenic cysts confirmed by surgery from July 2009 to April 2014 were retrospectively analyzed in the first affiliated Hospital of Zhejiang University Medical College. The clinical manifestations, imaging features, preoperative diagnosis, pathological features, treatment and prognosis of the patients were summarized and analyzed. Results there were 10 males and 14 females with the minimum age of 24 years and the maximum age of 76 years with an average age of 47.3 years. The clinical symptoms included cough and expectoration in 9 cases, chest tightness in 5 cases, chest pain in 4 cases, fever in 4 cases and asymptomatic in 6 cases. According to the imaging examination, the lesions were divided into intrapulmonary type and mediastinal type, including 9 cases of intrapulmonary type and 15 cases of mediastinal type. Typical CT is characterized by a uniform circular density, circular water density or soft tissue shadow or thin-walled cystic cavity, with clear boundary, relatively smooth edge, no enhancement or slight enhancement after enhancement. When the cyst is complicated with infection, the gas-liquid level can be seen in the cyst cavity. The typical features of MRI are homogeneous low signal on T1WI image and homogeneous high signal on T2WI image, but no obvious enhancement after enhancement. Preoperative diagnosis included bronchial cyst in 7 cases, lung cancer in 6 cases, neurogenic tumor in 3 cases, thymoma in 2 cases, pulmonary tuberculosis in 1 case, pulmonary abscess in 1 case and pulmonary bulla in 1 case. Pathological features: pseudociliary columnar epithelium, glandular body, cartilage, elastic fiber and a small amount of smooth muscle, neutrophil and inflammatory cell infiltration were observed under microscope. 14 cases underwent thoracotomy and 10 cases underwent thoracoscopic cysts resection. All the patients were followed up from 5 months to 62 months with an average of 36. 6 months. No recurrence of cysts occurred. Conclusion the clinical manifestations of bronchiogenic cysts in adults are mainly cough and sputum, chest tightness and shortness of breath. Chest CT and MRI are of great value in the diagnosis of bronchogenic cysts. The disease lacks specific clinical manifestations and imaging findings, and is sometimes misdiagnosed as other diseases. Surgical resection is the best method for the diagnosis and treatment of bronchial cysts.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R655.3
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