肺部良性肿块误诊为肺癌的原因分析

肺部良性肿块在临床上常误诊为肺癌，我院从１９７２年６月～１９９７年６月共行肺切除手术治疗肺部良性肿块１５４例，其中误诊为肺癌１０１例，误诊率６５．６％。现就其资料作一总结，并探讨其误诊的原因和防范对策。１临床资料１．１一般资料１０１例中男７９例，女２...     

误诊为周围型肺癌的肺内良性病灶37例CT表现对比及误诊分析

目的对比分析37例误诊为周围型肺癌的肺内良性病灶及37例同期确诊的周围型肺癌影像学特征,了解其鉴别要点,以提高诊断正确率,减少误诊。方法回顾性分析37例经CT检查被误诊为周围型肺癌,后经各类途径证实的肺内良性病灶CT影像资料,观察病灶的影像学特征,并与同期确诊的周围型肺癌37例进行对比分析。结果误诊组分叶征、毛刺征、空泡征比率均低于对照组,差异有统计学意义(P0.05);支气管充气征及空洞比率与对照组差异无统计学意义(P0.05)。结论肺内良性病灶可能具有部分与周围型肺癌相同或相似的影像学特征,在诊断中还需对病灶形态学细节进行分析,提高对病灶影像学特点的认识,并结合临床资料综合诊断,以减少误诊。     

肺部良性疾病68例误诊为肺癌分析

文献对肺癌误诊为其他疾病有较多报道，而有关肺部良性疾病误诊为肺癌的报道则较少。中山医科大学附属肿瘤医院在１９９１年８月～１９９７年８月期间，有６８例肺部良性包块术前误诊为肺癌而行手术治疗。本文对其误诊原因进行分析，并提出处理对策，以减少误诊误治。１临...     

肺部良性孤立性结节误诊为肺癌

目的通过对几种肺部良性孤立性结节病理基础分析,提出肺部孤立性结节良恶的鉴别诊断方法。方法回顾1995年1月至2006年12月本院收治的23例临床诊断为肺癌,术后病理证实为肺部良性孤立性结节。结果肺结核球、炎性假瘤和错构瘤是肺部常见的良性孤立性结节,术前均误诊为肺癌。结论肺内良性孤立性结节应依据病史和影像学进行鉴别诊断。     

误诊为肺结核114例分析

目的：探讨多种肺部疾病误诊为肺结核的原因,预防误诊。方法：回顾性分析了近20 a来我所门诊及住院患者中误诊为肺结核114例临床资料。结果：114例中肺癌误诊为肺结核最多,占62.3%,其次是支气管扩张等。结论：多种肺部疾病早期临床症状、X线表现不典型,容易误诊为肺结核,应予重视,避免误诊。     

55例误诊为肺癌的手术病例分析

目前,一般医务人员对支气管肺癌诊断的警惕性普遍增高,往往采取“宁左勿右”的手术治疗原则.由于肺癌的临床表现及 X 线征象,与胸部某些疾病如肺结核球、肺炎性假瘤等酷似,因此容易误诊为肺癌.现将1962～1986年误诊为肺癌的55例经手术病理检查最后确诊为胸部良性疾病进行分析.以探讨其误诊原因及经验教训,提高对胸部疾病的诊断能力.     

原发性支气管癌的X线不典型表现

由于普通X线胸片目前仍是诊断肺部疾病的首选手段，因此，认识原发性支气管癌(肺癌)的不典型X线表现，对及早发现肺癌有重大意义。肺癌在其各发展阶段病理基础不同，若合并其他病症，常使肺部X线表现缺乏特征性。我院1992～2003年共诊断肺癌198例，经X线胸片检查误诊20例，误诊率为10％。本文就误诊原因进行分析。     

误诊为肺癌的肺隐球菌病CT影像分析

目的探讨肺隐球菌病(pulmonary cryptococcosis,PC)CT影像表现及误诊原因,以提高诊断正确率。方法回顾性分析9例误诊为肺癌的PC临床资料。结果本组3例轻度咳嗽,6例无症状体检发现肺部占位,3例有基础疾病。9例均经CT检查发现肺部占位,其中5例单发结节型,4例多发结节或伴斑片型,均误诊为肺癌。2例经皮肺穿刺活检术病理检查确诊PC,7例经手术病理证实为PC。结论 PC的CT影像表现不典型,应注意与肺癌鉴别,怀疑PC时应首先行经皮肺穿刺活检术以取得病理诊断。     

肺外科误诊病例分析

从1973年4月至1986年12月,我院共行肺部手术954人次,如以术前第一诊断为肺结核,术后病理证实为其他疾病例为误诊标准,计有:肺曲菌病10例,支气管肺囊肿19例,支气管扩张7例,肺癌6例,肺脓疡3例,肺炎性假瘤4例,肺发育不全及腺瘤各2例,肺脂肪瘤,肺隔离症,肺畸胎瘤,肝疝各1例,共12个病种47例,现选择罕见及教意深的病例,分析其误诊原因如下:一、文气管扩张误诊为肺结核7例,男性4例,女性3例。     

不典型肺癌CT误诊65例分析

目的：分析不典型肺癌CT误诊的原因,以提高对不典型肺癌的认识水平。方法：回顾性经手术、病理及细胞学检查证实的不典型肺癌误诊病例65例的临床及CT资料。其中胸部CT平扫20例,平扫＋增强扫描45例。结果：误诊为肺结核28例,肺炎23例,慢性阻塞性肺病11例,支气管扩张2例,肺脓肿1例。误诊时间1～11个月。结论：不典型肺癌CT表现呈多样性,当肺部有多发病灶特别是合并基础疾病时,容易造成误诊。反复脱落细胞检查、及时纤支镜检、穿刺活检及密切随访复查是减少不典型肺癌误诊的有效方法。     

B-lines quantify the lung water content: a lung ultrasound versus lung gravimetry study in acute lung injury

B-lines (also termed ultrasound lung comets) obtained with lung ultrasound detect experimental acute lung injury (ALI) very early and before hemogasanalytic changes, with a simple, noninvasive, nonionizing and real-time method. Our aim was to estimate the correlation between B-lines number and the wet/dry ratio of the lung tissue, measured by gravimetry, in an experimental model of ALI. Seventeen Na-pentobarbital anesthetized, cannulated (central vein and carotid artery) minipigs were studied: five sham-operated animals served as controls and, in 12 animals, ALI was induced by injection of oleic acid (0.1 mL/kg) via the central venous catheter. B-lines were measured by echographic scanner in four predetermined chest scanning sites in each animal. At the end of each experiment, both lungs were dissected, weighed and dried to determine wet/dry weight ratio by gravimetry. After the injection of oleic acid, B-lines number increased over time. A significant correlation was found between the wet/dry ratio and B-lines number (r = 0.91, p < 0.001). These data suggest that in an experimental pig model of ALI/ARDS, B-lines assessed by lung ultrasound provide a simple, semiquantitative, noninvasive index of lung water accumulation, strongly correlated to invasive gravimetric assessment.     

Endogenous lung stem cells for lung regeneration

Introduction: Lifelong maintenance of a healthy lung requires resident stem cells to proliferate according to tissue requirements. Once thought to be a quiescent tissue, evolving views of the complex differentiation landscape of lung stem and progenitor cells have broad implications for our understanding of how the lung is maintained, as well as the development of new therapies for promoting endogenous regeneration in lung disease.

Areas covered: This review collates a large body of research relating to the hierarchical organization of epithelial stem cells in the adult lung and their role in tissue homeostasis and regeneration after injury. To identify relevant studies, PubMed was queried using one or a combination of the terms ‘lung’, ‘airway’, ‘alveoli’, ‘stem cells’, ‘progenitor’, ‘repair’ and ‘regeneration’.

Expert opinion: This review discusses how new technologies and injury models have challenged the demarcations between stem and progenitor cell populations.     

单肺通气中肺保护策略研究进展

目的 通过对单肺通气中肺保护策略研究进展的分析,为临床工作提供理论指导,减少单肺通气术中低氧血症和术后肺部并发症的发生.方法 应用计算机在Pubmed上检索2007年1月～ 2012年5月有关单肺通气的文章,检索词为:one lung ventilation,hypoxemia,lungprotection,限定文章语言种类为English.对资料进行初审,并查找全文.纳入标准:①有关单肺通气的实验及临床研究;②有关肺保护的试验研究.排除标准:①综述文献;②重复研究.共收集到200多篇有关单肺通气方面的文献,纳入14篇.结果 纳入的14篇文章中有关单肺通气术中管理方面的文献12篇,有关单肺通气时低氧血症方面的文献2篇.通过对入选文献进行分析、整理,将单肺通气术中管理从通气模式选择、潮气量与呼吸频率的设置、PEEP及CPAP的运用、吸入氧浓度及液体管理等5方面进行分析,归纳总结出目前在单肺通气时的肺保护策略和麻醉管理进展.结论 随着对单肺通气中肺保护的深入研究,单肺通气的麻醉管理将更加有效、合理.     

终末期肺病肺移植术后并发症的影像学表现

目的探讨肺移植术后并发症的影像学改变。方法6例患者进行了同种异体肺移植术,其中4例终末期慢性阻塞性肺疾病患者和1例为中毒性细支气管炎患者接受单肺移植,另1例为外周型肺腺鳞癌并双肺转移接受双肺移植。用胸片及CT观察术后并发症的影像学变化。结果6例肺移植手术全部成功,6例中围手术期3例死亡,3例已存活16~36个月。术后2例发生急性排斥反应,5例出现再移植肺水肿,3例并发肺部感染,2例出现气胸,2例术后1~2个月出现吻合口狭窄。结论及时的胸片和CT检查对肺移植术后并发症的防治有非常重要的指导价值。     

Massive brain injury enhances lung damage in an isolated lung model of ventilator-induced lung injury

OBJECTIVE: To assess the influence of massive brain injury on pulmonary susceptibility to injury attending subsequent mechanical or ischemia/reperfusion stress. DESIGN: Prospective experimental study. SETTING: Animal research laboratory. SUBJECTS: Twenty-four anesthetized New Zealand White rabbits randomized to control (n = 12) or induced brain injury (n = 12) group. INTERVENTIONS: After randomization, brain injury was induced by inflation of an intracranial balloon-tipped catheter, and animals were ventilated with a tidal volume of 10 mL/kg and zero end-expiratory pressure for 120 mins. Following heart-lung block extraction, isolated and perfused lungs were subjected to injurious ventilation with peak airway pressure 30 cm H2O and positive end-expiratory pressure 5 cm H2O for 30 mins. MEASUREMENTS AND MAIN RESULTS: No difference was observed between groups in gas exchange, lung mechanics, or hemodynamics during the 2-hr in vivo period following induction of brain injury. However, after 30 mins of ex vivo injurious mechanical ventilation, lungs from the brain injury group showed greater change in ultrafiltration coefficient, weight gain, and alveolar hemorrhage (all p < .05). CONCLUSIONS: Massive brain injury might increase lung vulnerability to subsequent injurious mechanical or ischemia-reperfusion insults, thereby increasing the risk of clinical posttransplant graft failure.