摘要目的 分析胸膜孤立性纤维瘤(SFTP)的临床特点及误诊原因,提高术前诊断水平.方法 回顾性分析自2004年1-6月同济大学附属上海市肺科医院收治的术前误诊的38例SFTP的临床资料及随访结果.结果 38例中,男18例,女20例,年龄20 ～ 78岁,平均(53.8±14.7)岁,病程7d至10年.就诊时21例无症状,17例有咳嗽、胸痛、胸闷等不同症状.血清肿瘤标志物水平正常者28例.术前诊断肺癌9例,间皮瘤5例,神经纤维瘤5例,肺良性肿瘤4例,肺部感染3例,炎性假瘤5例,脓胸2例,结核性胸膜炎3例,肺隔离症2例.误诊率为84.4％(38/45),误诊时间为14 d至10年,平均5.4个月.38例均行外科手术切除,诊断为良性SFTP 33例,恶性5例.随访1～ 118个月,中位随访45个月,失访3例,术后死亡2例,复发3例.结论 SFTP临床表现、血清学检查及胸部影像学表现缺乏特异性,临床容易误诊.支气管镜及经皮肺穿刺活检术诊断率不高.临床医生应提高对SFTP的警惕,对于拟诊患者应尽早手术明确病理,避免误诊.

abstractsObjective To improve the preoperative diagnostic rate of solitary fibrous tumor(SFTP) of the pleura through the analysis on clinical characteristics and misdiagnosis reasons of SFTP.Methods A retrospective review of the clinical records of 38 cases of SFTP in our hospital from January 2004 to June 2014 was conducted.The follow-up data were also reviewed.Results There were 18 males and 20 females,aging from 20 to 78 years (median,53.8 years).Twenty-one cases were asymptomatic while other 17 had cough,chest pain,chest tightness and other symptoms.The levels of serum tumor markers were normal in 28 cases.The preoperative diagnosis was lung cancer in 9 cases,pleural mesothelioma in 5,neurofibroma in 5,pulmonary benign tumors in 4,pulmonary infection in 3,inflammatory granuloma in 5,pyothorax in 2,tuberculous pleuritis in 3,and pulmonary sequestration in 2 cases.The misdiagnosis rate was 84.4％,with misdiagnosis time ranging from 7 days to 10 years (median,5.4 months).All the patients received thoracic surgical treatment.Among them,33 cases were diagnosed as benign SFTP while 5 were diagnosed as malignant SFTP.Follow-up periods ranged from 1 to 118 months (median,45 months).Three cases were lost,2 died 11 months and 18 months after operation,and 3 reported recurrence.Conclusion SFTP is a rare tumor which can be misdiagnosed easily.Awareness of its presentation and clinical course may help the clinician to consider referral to the thoracic surgeon for resection.