Surgical Diagnosis And Treatment Of 102 Cases Of Pulmonary Sclerosing Pneumocytoma

ObjectiveTo explore the clinical features,diagnosis,surgical treatment and curative effect observation of pulmonary sclerosing pneumocytoma.The relationship between the clinical symptoms and the location and size of the lesions was analyzed and the clinical value of thoracoscopic surgery and traditional surgery in diagnosis and treatment was also analyzed.In order to improve the diagnosis and treatment level of PSP,and provide relevant reference for clinicians.Methods1.The clinical data of 102 patients with PSP admitted to the Department of Thoracic Surgery,the First Affiliated Hospital of Zhengzhou University from January 2012 to October 2017 were retrospectively reviewed.All subjects were confirmed by surgery and postoperative pathological examination as sclerosing pulmonary cell tumor,pulmonary sclerosing hemangioma and sclerosing alveolar cell tumor.The medical records of 102 patients with sclerosing pulmonary cell tumor were reviewed and collected.2.According to the clinical symptoms of the patients,the patients were divided into the symptomatic group and the asymptomatic group.The patients were divided into the thoracoscopic treatment group(endoscopic group)and the traditional small incision thoracotomy group(open chest group).3.Data processing and analysis were performed using SPSS 21.0 statistical software.The measurement data conforming to the normal distribution was expressed by(x-±s),and the t-test was used between the two groups;the count data was expressed by frequency,and the comparison was performed by 2 test.With?=0.05 as the test level,the difference of P<0.05 was statistically significant.Results1.89(87.3%)were female and 13(12.70%)were male in the 102 subjects,more women than men.2.Seven of the 33 patients(21.21%)had higher serum CYFRA21-1(3.33 ng/ml to 9.09 ng/mL),with an average of 5.35 ng/mL,while CEA,NSE,CA-125 and other results were not See obvious abnormalities.3.Preoperative CT findings: 68(66.67%)patients in the whole group were in the right lung,36(35.29%)in the right lower lobe,59(57.84%)in the lower lobe,and 25(24.50%)in the upper lobe In the middle,17 cases(16.66%),1 case in the right hilar,1 case of multiple round nodules,and the remaining 101 cases were single masses.There were 43(42.16%)cases of central PSP and 59(57.84%)cases of peripheral type,There were no statistically significant clinical symptoms and tumor sites(P>0.05).The maximum diameter of the mass in the whole group was about 8.60 cm,the smallest diameter was 0.70 cm,and the maximum diameter was 2.86±1.32 cm.The clinical symptom group size ranged from 0.70 cm to 7.90 cm,and the maximum diameter average 3.09± 1.61cm;In the no clinical symptom group,the tumor size ranged from 1.00 cm to 8.60 cm,and the maximum diameter was 2.72±1.09 cm.There was no statistical difference between the presence or absence of clinical symptoms and the mean maximum diameter of the mass(P>0.05).4.All the 102 patients underwent surgery.69 patients underwent video-assisted thoracoscopic surgery(VATS),33 cases underwent traditional small incision thoracotomy.The operation time was 88.25±25.02 min in the laparoscopic group and 122.12±21.25 min in the thoracotomy group.The difference between the two groups was statistically significant(P<0.05).The intraoperative blood loss was 77.90±22.22 mL in the laparoscopic group and the intraoperative blood loss 125.61±24.07 mL in the thoracotomy group.The difference between the two groups was statistically significant(P<0.05).The drainage volume of the laparoscopic group was 352.17±140.13 mL in the first 3 days after operation and 424.55±123.52 mL in the first 3 days after operation in the open chest group.The difference was statistically significant(P<0.05).The postoperative hospital stay time 8.97±2.35 d and the postoperative hospital stay time 10.67±2.52 d in the laparoscopic group were statistically significant(P<0.05).5.Percutaneous lung biopsy was performed in 96 patients.The pathological return was confirmed by 88 cases(91.67%)with PSP.Postoperative pathological return mass: 72 cases(70.59%)soft,23 cases(22.55%)medium,7 cases(6.86%)hard.Under the microscope,PSP has two kinds of cells that constitute four basic histological structures: papillary,sclerosing,hemorrhagic and solid.Seventy-two(70.59%)patients had four histological structures,followed by 19(18.63%)consisting of three structures,and 11(10.78%)containing two structural components.A total of 39 lymph nodes were removed from the whole group,and the pathological returns were reactive hyperplasia.6.Immunohistochemistry was performed in 97 patients.The expression rate of EMA and TTF-1 was 100%,and was expressed in both epithelioid cells and round cells.Vimentin was positively expressed in 89 cases(91.75%)and was widely expressed in round cells and was not expressed in epithelial-like cells.Positive expression of CK in 84 patients(86.60%)and NapsinA(63 patients,64.95%)were found in epithelioid cells.Ki-67 is often expressed in round tumor cells,with a positive rate of 1% to 10%,and 23 patients with negative p40.Conclusions1.pulmonary sclerosing pneumocytoma is a benign tumor that occurs in middle-aged women.It often has no obvious symptoms.Sometimes it can be manifested as cough,cough and blood in the sputum.The clinical symptoms are not related to the size of the mass and the location of the tumor.CT or PET/CT has its characteristic imaging findings,but its diagnostic rate is low,often combined with pathological and immunohistochemical diagnosis.2.The treatment should be based on surgical treatment.Compared with traditional thoracotomy,thoracic surgery is the preferred treatment.PSP surgery is effective,even if recurrence or metastasis is performed again.The prognosis of patients is still good.Conclusions.