肺炎型肺癌诊断及鉴别诊断.docVIP

肺炎型肺癌诊断及鉴别诊断【摘要】 目的 探讨肺炎型肺癌的诊断及鉴别诊断。方法 回顾性分析32例肺炎型肺癌的临床、影像学及病理表现,探讨其诊断要点。结果 32例肺炎型肺癌中咳嗽、咳痰30例,发热20例,热型不一,胸闷气短14例,2例无明显症状体检发现。肿瘤大小2.1～11.7 cm,肺周边部24例,肺门部8例,病理示细支气管肺泡癌16例,腺癌12例,腺鳞癌2例,小细胞癌2例。结论 肺炎型肺癌多位于肺周边部,易误诊为肺炎,以细支气管肺泡癌、腺癌多见,抗炎治疗无效,需病理确诊,主要以手术治疗。? 【关键词】 肺炎型肺癌;诊断;鉴别诊断;临床;影像学?? The diagnosis and differential diagnosis of the pneumonia-lung cancer WANG Jun-cang,LI Zhao-fang,Wu Jie.Department of Internal Medicine,The city hospital of rizhao,Rizhao 276800,China 【Abstract】 Objective To investigate the diagnosis and differential diagnosis of the pneumonia-lung cancer.Methods The clinical, radiological and pathological findings of 32 case of pneumonia-lung cancer were retrospective analysis. Results There were of cough and sputum in 30 cases, fever in 20 cases, Chest tightness and shortness of breath in 14 cases,and 2 cases of no obvious symptoms. The tumor size was 2.1 ~ 11.7 cm. There were 24 cases of peripheral lung, 8 cases in hilar. There were 16 cases of bronchioloalveolar carcinoma, adenocarcinoma 12 cases, 2 cases of adenosquamous carcinoma, small cell carcinoma in 2 cases. Conclusion pneumonia-lung cancers often lie in the peripheral lung, and often misdiagnosed as pneumonia. Bronchioloalveolar carcinoma and adenocarcinoma were more common.The treatment is mainly surgeryand anti-inflammatory treatment is no benefit.? 【Key words】 Pneumonia-lung cance;Diagnosis;Differential diagnosis;Clinical ? DOI:10.3760/cma.j.issn 1673-8799.2010.11.49? 作者单位:276800山东省日照市东港区城区医院(王均仓);日照市两城医院(李兆芳);日照市人民医院病理科(武杰) 肺炎型肺癌影像学酷似肺炎,极易漏诊和误诊。本文就肺炎性肺癌诊断方法及影像学表现加以总结分析。? 1 资料与方法? 回顾性分析临床资料完整的经活检病理证实的肺炎型肺癌32例,男20例,女12例,年龄22~67岁,平均51岁。32例肺炎型肺癌中咳嗽、咳痰30例,阵发性干咳伴新鲜血丝11例,发热20例,体温37.6℃~38.7℃不等,胸闷气短14例,2例无明显症状体检发现。其中14例有吸烟史。无明显症状体检发现2例。全部病例均进行了X线摄影和CT平扫和增强扫描,采用仰卧位从肺尖至肺底横断扫描,14例行增强扫描。18例行纤支镜病理确诊,4例刷片细胞学确诊,24例经CT导引下穿剌活检病理确诊。? 2 结果? 32例肺炎型肺癌,其中30例有症状,2例无明显症状体检发现。肿瘤大小2.1～11.7 cm,肺周边部24例,肺门部8例,段性实性分布12例,叶形11例,斑片状8例,蜂窝状透亮影7例,支气管征11例,边缘不规则小结节13例,边界不清,密度不均匀。病理活检病理示细支气管肺泡