成人支气管源性囊肿临床分析

发布时间：2018-10-10 18:20

【摘要】：背景支气管源性肺囊肿是先天性肺囊性疾病中最常见的类型,约占先天性肺囊性疾病的50%。其发病机制目前尚不明确,通常认为是胚胎期原肠发出的胚芽部分发育障碍,其远端的原始支气管组织与近端组织脱离,形成盲管,腔内分泌物潴留所致,一般与正常支气管不相通。目前,国内外对支气管源性囊肿的研究主要以病例报道为主。支气管源性囊肿的临床表现无特异性,有时影像学表现也无明显特征,容易误诊为其他疾病,如肺癌、肺结核、胸腺瘤、神经源性肿瘤等。该病的治疗方法首选手术切除病灶,手术方式包括胸廓切开术和胸腔镜术。我们总结回顾了经手术病理确诊的24例成人支气管源性囊肿的完整资料,从临床表现、影像学特点、术前诊断、病理特点、治疗及预后等方面探讨该病,以提高对该病的诊治水平。目的探讨成人支气管源性囊肿的临床表现、影像学特点、术前诊断、病理学特点及治疗和预后,重点总结分析影像学特点及误诊原因,吸取经验教训,以期提高对支气管源性囊肿的诊治水平。材料与方法回顾性分析浙江大学医学院附属第一医院2009年7月至2014年4月经手术证实病理确诊的24例成人患者胸腔内支气管源性囊肿的完整资料,总结分析患者的临床表现、影像学特点、术前诊断、病理学特点、治疗及预后。结果其中男性10例,女性14例；最小年龄24岁,最大年龄76岁,平均年龄47.3岁。临床症状包括：咳嗽咳痰9例,胸闷气急5例,胸痛4例,发热4例,无症状者6例。根据影像学检查将病灶分为肺内型和纵膈型,其中肺内型9例,纵隔型15例。典型CT特征为密度均一的圆形、类圆形水样密度或软组织影或薄壁囊腔,界清,边缘较光整,增强后不强化或轻度强化。当囊肿并发感染时囊腔内可见气液平面。典型MRI特征为T1WI图像上呈均匀低信号,而T2WI图像上呈均匀高信号,增强后无明显强化。术前仅7例诊断为支气管源性囊肿,6例诊断为肺癌,3例诊断为神经源性肿瘤,2例诊断为胸腺瘤,1例诊断为肺结核,1例诊断为肺脓肿,1例诊断为肺大泡。病理特点：镜下见假覆层纤毛柱状上皮、腺体、软骨、弹力纤维及少量平滑肌,部分可见中性粒细胞、炎性细胞浸润。14例行胸廓切开术,10例经胸腔镜囊肿切除术。术后随访5个月至62个月,平均36.6个月,均未出现囊肿复发。结论成人支气管源性囊肿临床表现主要为咳嗽咳痰、胸闷气急,胸部CT及MRI对支气管源性囊肿具有较大诊断价值。该病缺乏特异的临床表现及影像学检查,有时容易误诊为其他疾病。手术切除是明确诊断和治疗支气管源性囊肿最佳方案。
[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.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R655.3

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