论文部分内容阅读
目的:探讨飞行人员肺结节的临床诊治特点及鉴定原则。方法:回顾性分析2000年1月至2019年3月空军特色医学中心39例肺结节患者的病史、X线胸片、胸部CT、PET/CT等结果，以及肺结节的诊治经过、飞行鉴定等资料，进行统计分析。结果:39例飞行人员肺结节患者中，发现时22例(56.4%)无呼吸道症状，X线胸片检查31例，所有患者均行胸部CT检查，其中16例(51.6%)X线胸片检查与胸部CT检查一致，PET/CT检查14例(35.9%)。首次影像学检查显示恶性结节与良性结节、性质待定结节相比，发现时最大径最大、长短径比值最小(n P值均<0.05)，随访影像学显示，恶性结节与其它两类结节相比，最大径变化幅度、面积变化幅度均为最高(n P值均<0.05)。胸部CT检查提示良、恶性结节密度、空泡征、边缘、分叶、毛刺比较，差异均有统计学意义(n P值均0.05)。发现结节就诊时，27例(69.2%)均在3个月以上的地面观察后做出飞行结论。n 结论:X线胸片用于肺结节的常规评估容易漏诊，胸部CT可进行评估和随访，PET/CT检查是CT检查的良好补充，有助于区分良恶性。发现肺结节后，无统一的飞行结论时间及流程、标准。“,”Objective:To analyze the characteristics and assessment of pulmonary nodules of aircrew.Methods:The medical history, chest radiographs, chest CT, PET/CT, diagnosis and treatment of pulmonary nodules, flight identification and other data of 39 patients with pulmonary nodules in Air Force Medical Center from January 2000 to March 2019 were analyzed retrospectively.Results:Among the 39 patients with pulmonary nodules, 22 cases (56.4%) had no respiratory symptoms at the time of discovery, Chest X-ray examination was performed in 31 cases (79.5%), Chest CT examination was performed in all patients.Chest X-ray examination was consistent with chest CT examination in 16 cases (51.6%). PET/CT examination was performed in 14 cases (35.9%). The first imaging examination showed that the maximum diameter of malignant nodules were the largest and the ratio of length to diameter of malignant nodules were the smallest when compared with benign nodules and nodules of undetermined nature (all n P<0.05). Follow-up imaging showed that compared with the other two types of nodules, malignant nodules had the highest range of maximum diameter and area variation (alln P<0.05). Compared with benign and malignant nodules, CT examination showed that the density, vacuolar sign, margin, lobulation, and spicule of the two kinds of nodules were statistically significant (alln P0.05), When nodules were found, 27 cases (69.2%) made the flight conclusion after more than 3 months of ground observation.n Conclusions:Chest X-ray for routine evaluation of pulmonary nodules is prone to miss diagnosis.Chest CT can be evaluated and followed up.PET/CT examination is a good supplement to CT examination, helping to distinguish benign from malignant.After the discovery of pulmonary nodules, there is no unified flight conclusion time, procedure and standard.