胸腔镜辅助治疗孤立性肺结节120例分析  

Video-assisted Thoracic Surgery for 120 Patients with Solitary Pulmonary Nodules

作　　者：苏雷[1,2] 支修益[1,2] 张毅[1,2] 许庆生[1,2] 钱坤[1,2] 李元博[1,2] 

机构地区：[1]首都医科大学肺癌诊疗中心 [2]首都医科大学宣武医院胸外科,北京100053

出　　处：《中国微创外科杂志》2013年第11期966-968,973,共4页Chinese Journal of Minimally Invasive Surgery

基　　金：科技部973计划项目(2011CB510100)

摘　　要：目的 探讨孤立性肺结节（solitary pulmonary nodule,SPN）的临床诊断和外科治疗方法.方法 对我院2006年1月～2012年6月手术治疗120例SPN进行回顾性分析.均经胸部CT扫描,肺周围结节82例,近肺门结节38例.术式包括单纯病变切除或剔除术22例,肺楔形切除术57例,肺段切除术9例,肺叶切除术32例.结果 术后病理证实恶性结节78例（65.0％）,包括肺原发恶性肿瘤51例,其中非小细胞肺癌39例（病理分期ⅠA期T1N0M0 19例,ⅡA期T1N1M09例,ⅢA期T1N2M0 11例）;转移瘤27例.良性结节42例（35.0％）.CT诊断肺恶性结节的敏感性为71.8％ （56/78）,特异性为33.3％ （14/42）;正电子计算机体层扫描（PET-CT）分别为93.4％（57/61）和76.0％（19/25）;经皮肺穿刺活检分别为92.8％（64/69）和100％（13/13）.结论 SPN的影像学静态特征在临床医生的分析判断中发挥着重要作用.对于有危险因素、直径＞ 10 mm的SPN,应积极采取对应的检查、诊断和治疗措施.Objective To explore the diagnosis and surgical treatment of solitary pulmonary nodules （SPN）.Methods The data of 120 cases of SPN-resection patients （73 males,47 females） in our hospital from January 2006 to June 2012 were retrospectively analyzed.All cases were confirmed by chest CT scan,including 82 cases of peripheral lung nodules and 38 cases with nodules near the lung hilum.Simple excision was performed in 22 cases,wedge resection in 57 cases,segmental resection in 9 cases,and lobectomy in 32 cases.Results Postoperative pathology confirmed malignant nodules in 78 cases （65.0％）,including 51 cases of primary lung cancer,of which non-small cell lung cancer was 39 cases：pathological stage：Ⅰ A （T1N0M0） 19 cases,Ⅱ A （T1N1M0） 9 cases,ⅢA （T1N2M0） 11 cases; and 27 cases of metastatic tumor.There were 42 cases of benign nodules （35.0％）.The sensitivity of CT diagnosis of malignant SPN was 71.8％ （56/78） and the specificity was 33.3％ （14/42） ; PET-CT sensitivity and specificity were 93.4％ （57/61） and 76.0％ （19/25） ; the sensitivity and specificity of percutaneous lung puncture biopsy were 92.8％ （64/69） and 100％ （13/13） respectively.Conclusions The SPN imaging features play an important role in the judgment of clinicians.For SPN with risk factors and with a diameter of more than 10 mm,corresponding examination,diagnosis and treatment measures should be carried out in time.

关 键 词：孤立性肺结节 胸腔镜外科 诊断 治疗 

分 类 号：R655.3[医药卫生—外科学]