胸膜孤立性纤维瘤5例并文献复习
胸膜孤立性纤维瘤5例并文献复习 【摘要】目的:探讨胸膜孤立性 纤维瘤 (solitary fibrous tumor of the pleura, SFTP)的诊断和治疗方法。方法: 回顾分析2010-2014年本院胸外科收治 的5例SFTP患者的临床资料,并综合国 内外文献复习。结果:患者包括男2例, 女3例;年龄53〜69岁,临床症状有胸 背痛、咳嗽、咳痰等。患者术前均行胸 部CT检查,且行经皮肺穿刺活检,诊断 阳性率40%;患者均行手术治疗,切除 率100%,术后恢复好,无并发症;术后 病理均证实为孤立性纤维瘤,其中1例 恶性;术后随访26个月〜6年,均存活, 无复发。结论:SFTP术前诊断困难,不 建议术前行经皮穿刺活检,若无禁忌证 可考虑直接手术探查,外科手术切除是 治疗SFTP唯一有效的治疗方法。 【关键词】孤立性纤维瘤;胸膜; 临床特点;手术治疗;术前检查 [Abstract] Objective: To investigate the diagnosis and treatment of the solitary fibrous tumor of the pleura (SFTP) .: A retrospective analysis of the clinical data of five patients with SFTP, who were admitted in our hospital from 2010 to 2014, and domestic and foreign literature were reviewed comprehensive.Result: 5 patients were included in our study with 2 male and 3 female, age from 53~69 years, clinical symptoms had chest pain, cough and expectoration.AII patients underwent chest CT examination before operation, and percutaneous lung biopsy was pered, the positive rate was 40%.All patients underwent surgical treatment, the resection rate was 100%, postoperative recovery was good and no complications.The postoperative pathological findings were solitary fibrous tumors, which 1 case was malignant.All patients were followed up for 26 months to 6 years, all patients were alive and without recurrence.Conclusion: Preoperative diagnosis of SFTP is difficult, percutaneous biopsy is not recommend, we recommend direct surgical exploration if there is no contraindications.Surgical resection is the only effective treatment with SFTP. [Key words] Solitary fibrous tumor; Pleural; Clinical characteristics; Surgical treatment; Preoperative examination 孤立性纤维浦(solitaryfibrous tumor, SFT)是一种较少见的软组织肿 瘤,其组织形态多样,发病部位广泛, 但最常见的是胸膜孤立性纤维瘤 (solitary fibrous tumor of the pleura, SFTP)o2010-2014年本院胸外科共收治5 例SFTP患者,治疗效果满意。现对其临 床表现、诊断、治疗、病理及预后等情 况进行分析总结。 1临床资料 1.1病例1男,63岁,以“左胸背 隐痛5年,活动后气促2年”为主诉于 2011年4月入院。阳性体征有:左下肺 语颤减弱,叩诊浊音,呼吸音低,双下 肢水肿,杵状指阳性。胸部CT检查提示: 左下肺巨大占位,20.0 cm X 16.2 cm X 11.0 cm,密度欠均匀,考虑胸膜孤立性 纤维瘤可能性大。术前行经皮肺穿刺活 检提示:孤立性纤维瘤。支气管镜检查 提示:左下叶基底干外压性狭窄。手术 经后外侧切口进行,完整切除肿瘤。术 后病理:瘤组织20.0 cm X 15.0 cm X 10.0 cm,表面呈分叶状,包膜完整,切 面灰白、灰黄,考虑孤立性纤维瘤,核 分裂2/10 HPF,被膜(-)o术后随访5 年,无复发。 1.2病例2女,56岁,以“反复咳 嗽、咳痰1周余”为主诉于2010年4月 入院。阳性体征有:左下肺浊音,左下 肺呼吸音弱,可闻及湿??音。胸部CT检 查提示:左侧胸壁见一肿块突向左肺野, 最大截面积8.2 cm X6.4 cm,边界清,密 度欠均匀。行经皮肺穿刺活检提示:血 凝块,未见组织。术前未行支气管镜检 查。手术经后外侧切口进行,完整切除 肿瘤,术后病理:瘤组织19 cmXlO cm X5.5 cm,表面光滑,切面呈灰白实性变, 质韧,未见坏死及出血,考虑胸膜孤立 性纤维瘤。术后随访6年,无复发。 1.3病例3女,53岁,以“右侧胸 背部疼痛1个月”为主诉于2010年9月 入院。阳性体征有:右侧胸廓饱满,右 肺语颤减弱,右肺呼吸音弱,未闻及?? 音。胸部CT检查提示:增强:右上胸腔 巨大类圆形占位,最大截面12.7 cm X 10.5 cm,密度尚均匀,CT值76~82 hu, 边界规整,其内缘与肺分界清楚,右上 肺受压不张,增强后肿块周缘呈明显持 续强化,中心多发低密度区强化不明显。 术前行经皮肺穿刺活检提示:软组织肿 瘤,侵向良性,组织过少,无法分类。 支气管镜检查提示:右上叶尖段、右下 叶基底段、背段管腔外压性狭窄至闭塞。 手术经后外侧切口进行,分块完整切除 肿瘤,术后病理:圆形肿物一块,20.0 cm X 13.0 cm X 7.0 cm,表面光滑,切面成 灰黄色,实性,部分区域出血伴囊腔形 成,考虑胸膜孤立性纤维瘤。术后随访 66个月,无复发。1.4病例4男, 63岁,以“气喘1周”为主诉于2012 年10月入院。阳性体征有:左肺呼吸音 低,叩诊呈浊音。胸部CT检查提示:左 侧胸腔巨大占位,肿瘤大小约14.1 cm X 8.7 cmX 15.2 cm, CT 值 29—41 hu,边界 清楚,周边组织受压,增强后呈不均匀 强化,可见迂曲强化血管影,考虑孤立 性纤维瘤。术