SFTP误诊原因分析.docVIP

精品论文 参考文献 SFTP误诊原因分析 许川 李震宇 孙勇攀 梅宏 [摘 要]目的 分析孤立性纤维瘤(solitary fibrous tumor pleura, SFTP)的误诊原因，提高对SFTP的认识，降低SFTP的误诊率。方法 回顾分析2008年5月至2013年8月贵州省人民医院胸外科收治的19例SFTP患者的临床资料，重点分析其临床诊断特点及造成误诊的原因。结果19例患者中，病程5d~5年，术前诊断：神经源性肿瘤9例，胸膜间皮瘤5例，肺癌3例，SFTP 2例。所有病例均行肿瘤根治性切除术，术后病理学检查和免疫组织化学结果均为良性SFTP。术前诊断准确率仅为10.5%。术后17例随访4月~5年，失访2例，随访病例均未发现复发和(或)转移。结论 SFTP临床症状不典型，易误诊为神经源性肿瘤或胸膜间皮瘤等常见肿瘤。对于胸腔内边界清楚的肿瘤，且无间质侵润和淋巴结肿大的患者，支气管镜排除常见肿瘤后，应进行CT三维重建，观察是否具有“蒂”征及胸部??视下改变体位时带蒂肿瘤的运动，有助于降低SFTP的误诊率。 [关键词]纤维瘤 胸膜疾病 误诊 The Reasons of Misdiagnosis of Solitary Fibrous Tumor Pleura (SFTP) Xu Chuan, Li Zhenyu, Sun YongPan, Mei Hong Abstract: Objective To analyze the reasons of misdiagnosis of solitary fibrous tumor pleura (SFTP) and find the methods to decrease the misdiagnosis rate. Methods The clinical data of 19 SFTP between May 2008 and August 2013 were investigated retrospectively. The clinical presentations and causes for the misdiagnoses were analyzed. Results The preoperative diagnosis among the 19 patients was neurogenic tumor in 9 cases, pleural mesothelioma in 5, lung cancer in 3 and SFTP in 2. All the cases underwent radical resection, and postoperative pathology and immunohistochemical study confirmed optimum SFTP in all the cases, with a preoperative accurate rate of only 10.5%. Follow-up ranged from 4 months to 5 years. Two cases were lost, remaining 17 cases reported no recurrence or metastasis. Conclusion The early stage of SFTP appears to have no evident symptom. CT is valuable for qualitative diagnosis of SFTP. The recognition of the clinical characteristics of SFTP is essential for improving the diagnosis of this uncommon disease. Key words: fibroma; pleura diseases; diagnostic errors 孤立性纤维瘤(solitary fibrous tumou pleura, SFTP)是一种罕见的、生长缓慢的间叶组织肿瘤，其发病率占全部胸膜肿瘤的5%[1,2,3]，且SFTP的临床症状、血液学检查指标及影像学表现缺乏特异性，导致术前诊断困难，误诊率高。为提高SFTP的术前诊断率，减少漏诊和误诊，我们对2008年5月至2013年8月贵州省人民医院胸外科收治的19例SFTP患者的临床资料进行回顾性分析，现报道如下。 1 资料与方法 1.1 临床资料 本组共19例患者，其中男11例，女8例；年龄在40~71岁，平均年龄54岁；病程5天~5年。临床