您现在的位置: 范文先生网 >> 医学论文 >> 基础医学论文 >> 正文

胸廓入口区气管旁含气囊肿的CT及临床表现

时间:2006-11-26栏目:基础医学论文

  胸廓入口区气管旁含气囊肿的CT及临床表现
  
  作者:张传玉 王军伟
  
  【摘要】  目的 探讨胸廓入口区气管旁含气囊肿的CT及临床表现。方法 总结45例胸部常规CT扫描中发现的胸廓入口区气管旁含气囊肿,分析其部位、大小、形态、边缘、临床症状及肺部CT表现。以40例非患有胸廓入口区气管旁含气囊肿的病例作为对照组,对比分析两组肺功能、气管指数及肺气肿计数。结果 45例胸廓入口区气管旁含气囊肿均位于胸腔入口区的气管旁右后外侧,其中20例(44%)位于第2胸椎水平,38例(84%)位于气管旁右侧。CT均表现为不规则形或卵圆形的含气囊肿,囊内有不规则线状、索条状分隔(53%),平均大小为1 cm×1 cm×2 cm,外缘多呈不规则分叶状,壁厚薄不一(16%)。薄层扫描可见到囊肿和气管间的含气交通细管,三维重建图像可见到软组织密度的交通管道和在气管内壁上的开口。病例组FEV1/FVC和FEF25%——75%显著低于对照组(F=5.474、11.355,P<0.05),而两组FVC%、FEV1%差异无统计学意义。病例组与对照组的气管指数及肺气肿计数的差别有显著的统计学意义(F=32.600、29.740,P<0.01)。结论 位于胸腔入口处气管右外后侧和气管间有细管状交通的含气囊肿影是本病最可靠的CT征象。它的发生与慢性肺疾患密切相关。
  
  【关键词】  囊肿;气管;体层摄影术,X线计算机
  
  [ABSTRACT] Objective To discuss the CT and clinical manifestations of paratracheal air cysts in the thoracic inlet. Methods Data of 45 cases of paratracheal air cysts (PAC) in the thoracic inlet found with conventional CT examination were analyzed for their location, size, form, margin, clinical symptoms and the manifestations in lung. Forty patients with nonPAC were enrolled and served as controls. Pulmonary function, tracheal and emphysema indices were compared. Results All the cysts were situated on the right posterolateral aspect of the trachea of the thoracic inlet, of which, 20 lesions (44%) located at T2 level and 38 (84%) at the right trachea. On CT scans, all cysts displayed as irregular or round aircontaining lesions, with irregular linear septal (53%) within the cyst and irregular lobulated outline (16%)。 The mean size of the lesions was about 1 cm×1 cm×2 cm. On thinsection scans, a fine communicating channel between the cyst and trachea was found in 14 cases. Clinically, 36 patients (80%) showed respiratory symptoms. FEV1/FVC and FEF25%-75% in the patients with this problem were significantly lower than that in the control group (P<0.05)。 However, FVC%, FEV1%, and proportion of obstructive pattern between the two groups were not significantly different. The differences between the tracheal indices and CTdetermined emphysema scores were significant (P<0.01)。 Conclusion A paratracheal air cyst situated at the thoracic inlet with a fine communicating channel with the trachea is the most reliable CT sign of the disease, which is closely related to the pathogenesis of chronic pulmonary diseases.
  
  [KEY WORDS] Cysts; Trachea; Tomography, Xray computed
  
  胸廓入口区气管旁含气囊肿并不很罕见,但国内外相关文献报道很少[1].自TANAKA等[2]1997年报道3例及GOO等[3]1999年报道60例后,引起了大家重视。在诸多的胸廓入口区气管旁含气囊肿中,术后组织病理学证实,气管憩室较常见[4].气管憩室常并发肺气肿,因为肺气肿可增加气管内压,而胸廓入口区是气管胸内段与胸外段的移行区,支持较少,故易导致胸廓入口区气管局部向外凸,形成气管憩室[1].作者总结我院一组胸廓入口区气管旁含气囊肿的CT表现,旨在探讨其与慢性阻塞性肺疾病(COPD)的关系及提高对本病的认识。
  
  1 资料与方法
  
  1.1 一般资料
  
  1.1.1 病例组 搜集我院2002年3月——2008年11月经CT平扫诊断的胸廓入口区气管旁含气囊肿病例共45例,男28例,女17例;年龄32——78岁,平均52.4岁,其中≥50岁者35例。有咳嗽、咳痰、咯血、气喘或憋气等呼吸道症状者36例。
  
  1.1.2 对照组 搜集我院同期经CT诊断的非患有胸廓入口区气管旁含气囊肿的病例40例,其中男25例,女15例;年龄30——75岁,平均53.2岁。有咳嗽、咳痰、咯血、气喘、胸痛等呼吸道症状者33例。
  
  1.2 肺功能测定
  
  23例胸廓入口区气管旁含气囊肿的病人及20例对照组病人行肺功能检查。主要监测指标:用力肺活量(FVC)、第一秒用力呼气量(FEV1)、肺活量在25%——75%间的用力呼气流量(FEF25%——75%)[3].根据MORRIS等[5]的公式,分别计算出FVC%、FEV1%、FEF25%——75%.CT检查及肺功能检查时间间隔小于4周。
  
  1.3 影像学检查方法
  
  全部病例均行胸部常规CT扫描,所用设备有GE Lightspeed 8层螺旋CT扫描仪、GE Lightspeed 16层螺旋CT扫描仪等。扫描采用CT平扫,床速27.5 mm/rot,常规扫描层厚10 mm,探测器开放1.25 mm×8、1.25 mm×16,螺距1.375∶1,矩阵 512×512.本文病例组全部行横断面薄层重组和冠状面、矢状面多平面重组(MPR),图像的层厚为1.25 mm,层间距为1.25 mm,其中8例对病变加做表面遮盖法的三维重建,10例加做CT仿真气管镜重建,5例加做呼气后憋气及吸气后憋气状态下CT平扫。
 

[1] [2] [3] 下一页

下页更精彩:1 2 3 4 下一页