支气管囊肿14例临床分析并文献复习

发布时间：2018-05-25 01:00

本文选题：支气管囊肿 + 临床表现　；参考：《广西医科大学》2013年硕士论文

【摘要】：目的：分析支气管囊肿确诊病例的诊断和治疗情况,总结其临床资料特点,为支气管囊肿的诊治工作提供参考。方法：回顾性分析我院2003年3月至2012年3月共9年来的14例经手术及病理证实的支气管囊肿患者的临床表现、影像学资料、病理学资料及治疗方法,并结合国内外文献进行讨论。结果：①男女比例1：1,年龄17-65岁,平均年龄(39.6±14.7)岁,其中青年人(18-45岁)7例(7/14)。②临床特征：胸痛(8/14),咳嗽(5/14)、呼吸困难(5/14)为最常见临床症状,14例均无发热、盗汗、消瘦、乏力等全身症状,无症状因体检发现者4例(4/14)。③影像学特征：纵隔型共12例,肺内型2例；纵隔型中以后纵隔(7/12)及上纵隔(4/12)多见。14例均表现为单发类圆形囊性病灶,囊壁厚度集中在1-5mm之间,边缘光整薄壁囊肿,无分叶、密度不均、毛刺,无浸润影、胸膜凹陷征、周围毛玻璃影等表现。囊肿内水样密度者(9/14)多见,其次为软组织密度影(2/12)与气性空洞(2/12)。增强扫描后3例囊壁轻度强化(3/10)。④血清学特点和器械检查：2例术前血常规白细胞及中性粒细胞比值增高,术后抗感染后复查恢复正常范围,余病例血清学检查无异常。1例患者腹部超声提示合并肝囊肿。1例合并左肾囊肿。11例患者行肺功能检查均无明显异常。⑤病理学特点：14例均为单个囊性包块,单房12例(12/14),多房2例(2/14)；光学镜下,14例(14/14)囊壁组织均发现假复层纤毛柱状上皮、平滑肌、纤维组织及浆液性或粘液性腺体,6例(6/14)发现软骨,2例(2/14)见炎症细胞。⑥治疗及预后：14例患者均经外科手术治愈,随访无异常。结论①支气管囊肿属于先天性少见病,病程长短不一,进展缓慢。 ②支气管囊肿最常见呼吸道症状为轻微胸痛、咳嗽及呼吸困难,而发热等全身症状少见。部分患者可无症状。 ③影像学表现为纵隔或肺内孤立的、边缘光整、密度均匀薄壁水样囊性肿块,以纵隔型多见。易误诊为纵隔神经源性肿瘤、肺大泡、肺脓肿、肺曲菌病等。 ④组织病理学镜下见囊壁内衬假复层纤毛柱状上皮,囊壁含成熟软骨、支气管平滑肌、粘液或浆液腺体细胞等为确诊依据。 ⑤手术治疗效果好,预后好。
[Abstract]:Objective: to analyze the diagnosis and treatment of bronchial cysts, and to summarize the clinical data and provide reference for the diagnosis and treatment of bronchial cysts. Methods: the clinical manifestations, imaging data, pathological data and treatment methods of 14 patients with bronchial cyst confirmed by operation and pathology were retrospectively analyzed from March 2003 to March 2012. And combined with the domestic and foreign literature to discuss. Results the ratio of 1: 1 to 1: 1 was 17-65 years old, with an average age of 39.6 卤14.7 years. The clinical features of 7 / 7 / 14.2 cases of young people aged 18-45 years were as follows: chest pain 8 / 14, cough 5 / 14, dyspnea 5 / 14). The most common clinical symptoms were none of the 14 patients with fever, night sweating, wasting, fatigue and other systemic symptoms. The imaging features of 4 cases of asymptomatic finding due to physical examination were as follows: mediastinal type 12 cases, intrapulmonary type 2 cases, mediastinal type 7 / 12) and superior mediastinum 4 / 12). 14 cases showed single round cystic lesions, and the thickness of cystic wall was concentrated between 1-5mm. Thin-wall cysts, without lobes, uneven density, burr, no infiltrating shadow, pleural indentation, perivitreous shadow and so on. Water density in cysts was 9 / 14), followed by soft tissue density (2 / 12) and air cavity (2 / 12). The serological characteristics of 3 / 10 / 10.4 cases with mild enhancement of cystic wall after enhanced scanning and the instrument examination showed that the ratio of white blood cell and neutrophil increased in 2 cases before operation, and returned to normal range after anti-infection after operation, and the ratio of leukocyte and neutrophil was increased in 2 cases before and after operation. There was no abnormality in serological examination in the remaining cases. 1 cases of liver cysts were diagnosed by abdominal ultrasound. 1 case with left renal cysts. All 14 cases were single cystic mass with no obvious abnormal 5. 5 pathological features of pulmonary function examination. 12 / 14 of monocyst, 2 / 14 / 14 of multiloculars, 14 / 14 of 14 / 14 / 14 of cysts under optical microscope, all of them showed pseudo-lamellar cilia columnar epithelium and smooth muscle. 6 cases of fibrous tissue and serous or mucinous glands 6 / 14) 2 cases of chondrosis were found 2 / 14) inflammatory cell .6 treatment and prognosis of 14 cases were cured by surgical operation and no abnormal follow-up was observed. Conclusion 1 bronchial cyst is a rare congenital disease with different duration and slow progression. 2 the most common respiratory symptoms of bronchial cyst are mild chest pain, cough and dyspnea, but fever is rare. Some patients are asymptomatic. 3 the imaging findings were solitary mediastinal or intrapulmonary, smooth margin, homogeneous thin-wall water-like cystic mass, mediastinal type. Easily misdiagnosed as mediastinal neurogenic tumor, alveoli, pulmonary abscess, pulmonary aspergillosis, etc. 4 under histopathological examination, pseudostratified ciliated columnar epithelium was found in the cyst wall. Mature cartilage, bronchial smooth muscle, mucous or serous glandular cells were the basis of diagnosis. 5 the effect of operation is good and the prognosis is good.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R562.2

【参考文献】