| Background:Pulmonary hamartoma(PH)is the most common benign lung tumor and its characteristic imaging manifestations are "popcorn like calcification".Due to the lack of specific clinical manifestations in patients with pulmonary hamartoma,the characteristic imaging manifestations were relatively rare.Some patients with pulmonary hamartoma could not be clearly diagnosed by preoperative imaging examination,and the final diagnosis still depended on pathological examination.Minimally invasive surgery has become the mainstream of thoracic surgery,and is increasingly used in the treatment of pulmonary lesions.Surgical treatment can not only diagnose pulmonary hamartoma that cannot be clearly defined before surgery,but also is an important means to treat pulmonary hamartoma.However,whether pulmonary hamartoma needs surgery is still controversial,how to deal with pulmonary hamartoma without characteristic imaging manifestations,and how to choose the surgical indications and surgical methods are the problems we are currently facing.Objective(s):This paper analyzed the diagnosis and treatment of 46 patients with pulmonary hamartoma in the Department of Thoracic Surgery,the First Affiliated Hospital of Kunming Medical University,the clinical features and imaging features of pulmonary hamartoma were summarized and the comparison of minimally invasive and thoracotomy was made to summarize the diagnosis and treatment experience of pulmonary hamartoma.Methods:The clinical data of 46 patients with pulmonary hamartoma diagnosed by pathology after surgical treatment in the thoracic surgery department of the first affiliated hospital of kunming medical university from June 2016 to June 2019 were collected,and the clinical and imaging characteristics of 46 patients with pulmonary hamartoma were retrospectively analyzed.17 patients with pulmonary hamartoma who underwent thoracotomy were selected as the control group,and 29 patients with pulmonary hamartoma who underwent minimally invasive surgery were selected as the experimental group.The differences in operation time,postoperative 24h drainage volume,postoperative catheter insertion time,and postoperative hospital stay time were compared between the two groups.Results:Among the 46 patients with pulmonary hamartoma,there were 18 males and 28 females,with a male-to-female ratio of 1:1.6.The average age is 49.3 years old,and the majority of the population is between 40 and 50 years old,accounting for 50%.A small number of patients have fever,cough,sputum,chest pain,chest tightness,shortness of breath and other symptoms,and most of the patients have lung lesions found by physical examination.All cases were intrapulmonary hamartomas,of which 21 were located in the left lung(12 in the upper lobe,9 in the lower lobe),and 25 in the right lung(8 in the upper lobe,5 in the middle lobe,and 12 in the lower lobe).The diameter of the lesion was 0.4-3.3cm,including 11 cases with a diameter less than 1cm,21 cases with a diameter of 1.0-2.0cm,12 cases with a diameter of 2.1-3.0cm,and 2 cases with a diameter greater than 3.0cm.The imaging findings were lobulated in 12 cases,calcified in 18 cases,burr or pleural traction in 2 cases,and thick-walled cavity in 1 case.Preoperative diagnosis of pulmonary hamartoma included 10 cases,8 cases of benign lung tumor,9 cases of lung cancer,3 cases of pulmonary tuberculosis tumor,16 cases of unclear nature,and the misdiagnosis rate was 78.3%(36/46).Thoracotomy(anterolateral incision)and anterolateral small incision(?10cm)3 cases and 29 cases underwent minimally invasive surgery.The surgical methods adopted included simple tumor excision in 2 cases,wedge-shaped pulmonary resection in 39 cases,segmental pulmonary resection in 2 cases and lobectomy in 3 cases.In the thoracotomy group,the operative time was 115.41 ±39.05min,the postoperative 24-hour drainage volume was 302.94± 141.10ml,the Postoperative indwelling drainage tube time was 49.58±14.10h,and the postoperative hospitalization time was 6.75±1.46d,while in the minimally invasive group,the operative time was 80.93±33.83min,the postoperative 24-hour drainage volume was 180.34±91.75ml,the Postoperative indwelling drainage tube time was 41.90±6.47h,and the postoperative hospitalization time was 5.28±1.41 days,all of which were less than that in the thoracotomy group,and the differences were statistically significant(P?0.05).A11 the patients were pathologically diagnosed as pulmonary hamartoma after surgery,among which 1 case was associated with lung cancer.No perioperative death occurred in all patients,and no serious postoperative complications occurred.All patients recovered well and were cured and discharged.Conclusion(s):1.Lung hamartoma is found in patients aged 40-50 years,most patients have no clinical symptoms,and those with symptoms have no specificity.2.Pulmonary hamartoma with no characteristic imaging manifestations is likely to be confused with lung cancer and pulmonary tuberculosis,which can be further clarified through CT combined with other auxiliary examinations.If the diagnosis is still in doubt,patients with pulmonary malignant tumors cannot be excluded,especially those patients suspected of non-small-cell lung cancer should choose surgical resection for pathological diagnosis.3.Lung hamartoma with characteristic imaging manifestations can be diagnosed by CT.For asymptomatic patients diagnosed with lung hamartoma by imaging data or thoracoscopic needle aspiration biopsy,follow-up observation can be selected,patients with concomitant symptoms should be excised surgically if conservative treatment fails.4.In the treatment of pulmonary hamartoma,minimally invasive surgery is more advantageous than thoracotomy. |
PDF Full Text Request