误诊SFTP误诊原因分析

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SFTP误诊原因分析

许川李震宇孙勇攀梅宏

许川李震宇孙勇攀梅宏

[摘要]目的分析孤立性纤维瘤(sol itaryfibrous tumor pleura,SFTP)的误诊原因提高对SFT P的认识降低S FT P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SFT P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SFT P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”征及胸部透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 Sol itary Fibrous Tumor Pleura (SFTP)

Xu Chuan, LiZhenyu,SunYongPan,Mei Hong

Abstract:Objective To analyze the reasons of misdiagnosis of sol itary fibrous tumorpleura (SFTP) and find the methods to decrease the misdiagnosis rate.Methods Thecl inical data of 19SFTP between May 2008 and August 2013 were investigated retrospectively.The cl inical presentations and causes forthe misdiagnoses were analyzed.Results The preoperative diagnosis among the 19 patients was neurogenic tumor in 9 cases,pleural mesothel ioma in 5, lung cancer in 3 and SFTP in 2.Al l the cases underwent radical resection, and postoperative pathology and immunohistochemical study confirmed optimum SFTP in al l the cases,with a preoperative accurate rate of only 10.5%. Fol low-up ranged from 4 months to 5 years.Two cases were lost, remaining 17 cases reportedno recurrence or metastasis.Conclusion The earlystage of SFTP appears to have no evident symptom.CT is valuable forqual itative diagnosis of SFTP.The recognition of thecl inical characteristics of SFTP is essential for improving the diagnosis of this uncommondisease.

Key words: fibroma;pleura diseases;diagnostic errors

孤立性纤维瘤(sol itaryfibrous 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S FT P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S FT P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