细支气管肺泡癌的CT分型及其临床意义

目的 评价细支气管肺泡癌（BAC）的CT分型及其临床意义。资料与方法 搜集经病理证实的BAC43例。按CT和HRCT的表现形式将其分为局限型和弥漫型，并分析局限型和弥漫型BAC的临床表现、CT特征、治疗方案和预后等特点。结果 （1）局限型26例。呈胸膜下区分布，含磨玻璃密度结节和实性密度结节，有分叶、毛刺、胸膜凹陷征、空泡征和细支气管充气征等。临床无症状者17例，咳嗽、痰中带血和胸痛9例。26例进行根治性肺叶切除，术后随访18例，其中死亡7例，生存期16～38个月，平均27．7个月。（2）弥漫型17例。肺实变16例，2个孤立病灶位于2个肺叶1例。实变内见“枯树枝征”11例，“峰窝征”4例，叶间裂膨隆7例；磨玻璃密度影12例，腺泡结节14例，分布于实变影的边缘和／或非实变的肺叶。4例X线胸片仅显示实变病灶而没有显示远离实变区的结节。咳嗽11例，咯大量泡沫痰8例，伴痰中带血3例；憋气7例。肺叶根治性切除3例。随访17例，死亡12例，生存期2～13个月，平均6．1个月。结论 根据CT和HRCT表现，BAC可分为局限型和弥漫型。两型BAC的临床表现、治疗方案和预后皆不同。

CT Types of Bronchioloalveolar Carcinoma and the Clinical Significance of the Classification

Objective To investigate the types of bronchioloalveolar carcinoma (BAC) according to the CT features and its clinical significance.Materials and Methods The BAC were divided into solitary and diffuse types according to the features of CT and HRCT scans in 43 patients of BAC who were pathologically proved. The characteristics of two types in clinical manifestations, CT features, therapy project and prognosis were retrospectively analyzed.Results (1) Solitary type 26 cases. The HRCT features of solitary type BAC included ground glass or solid density nodule, lobulation, spicule, pleural indentation, air bronchogram in subpleural area. 17 patients of solitary type BAC were asymptomatic. The clinical symptoms were cough, bloody sputum and chest pain in 9 cases. All 26 patients were performed radical pulmonary lobectomy. 18 patients were followed up after surgery and 7 of them died. The median survival was 27.7 months. (2) Diffuse type 17 cases. The HRCT features of diffuse type BAC included lobar or segmental consolidation (n=16) and associated findings of consolidation, such as leafless tree sign (n=11), honeycomb sign within the consolidation (n=4), bulging of the interlobar fissure (n=7), and ground glass opacity (n=12) and/or alveolar nodules (n=14). 2 solitary nodules in 2 lobes were found in 1 case. Of 4 cases, alveolar nodules remote from consolidation were not displayed on conventional X radiography. The clinical symptoms included cough (n=11), copious amounts of mucoid sputum (n=8), bloody sputum (n=3) and dyspnoea (n=7). 3 patients were performed radical pulmonary lobectomy. 17 patients were followed up and 12 of them died. The median survival was 6.1 months.Conclusion The BAC is divided into solitary and diffuse types according to the features of CT and HRCT scans. The characteristics of two types in clinical manifestations, therapy project and prognosis are different.