孤立性肺结节良、恶性危险因素分析和外科诊治  

Character of Solitary Pulmonary Nodules:Analysis of Risk Factors and Surgical Treatment

作　　者：蒋彬[1] 孙天宇[1] 邓波[1] 郭伟[1] 周景海[1] 王如文[1] 谭群友[1] 

机构地区：[1]第三军医大学大坪医院野战外科研究所胸外科,重庆400042

出　　处：《中国胸心血管外科临床杂志》2016年第7期702-705,共4页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：军队临床高新技术重大项目(2010gxjs073);第三军医大学临床科研重点项目(2007XG062)~~

摘　　要：目的 总结分析孤立性肺结节（SPN）的良恶性危险因素和外科诊治经验。方法 回顾性分析2008年1月至2014年5月在第三军医大学大坪医院经电视胸腔镜手术（VATS）切除并获得明确病理诊断的327例SPN患者的临床资料,其中男183例、女144例,年龄56.6（20~79）岁。结果 单因素分析结果显示,年龄、吸烟指数、结节最大径、毛刺、分叶、胸膜牵拉征、空洞、血管集束征、钙化在良恶性SPN之间的差异有统计学意义（P〈0.05）。多因素分析结果显示：年龄（P=0.004,OR=1.084）、结节最大径（P〈0.001,OR=1.467）、毛刺（P=0.001,OR=8.754）、分叶（P〈0.001,OR=10.424）、胸膜牵拉征（P=0.002,OR=6.619）是SPN的独立危险因素。全组平均手术时间（121.4±47.6）min,术中失血量（105.3±57.8）ml,术后住院时间（7.3±2.4）d,诊断准确率99.7%,中转开胸率1.5%,术中并发症发生率0.5%,无围术期死亡。结论 患者年龄、结节最大径、毛刺、分叶、胸膜牵拉征是判断SPN良恶性的独立危险因素。VATS是诊治SPN的安全、有效手段。Objective To summarize the experience of diagnosis and surgical treatment for solitary pulmonary nodules（SPN）. Methods We retrospectively analyzed clinical data of 327 patients with video-assisted thoracoscopic surgery（VATS） lung resections and subsequent pathological diagnosis of the SPNs in Daping Hospital from January 2008 through May 2014 year. There were 183 males, 144 females at age of 56.6（20-79） years. Results One way analysis of variance showed that there were significant differences in age, smoking index, diameter, glitches, lobulation, traction of pleural, cavity, vascular convergence, calcification between benign and malignant lesions（P〈0.05）. Logistic regression analysis revealed that age（P=0.004, OR=1.084）, diameter（P〈0.001, OR=1.467）, glitches（P=0.001, OR=8.754）, lobulation（P〈0.001, OR=10.424）, traction of pleural（P=0.002, OR=6.619） were independent predictors of malignancy in patients with SPN. Operation time was 121.4±47.6 min. Blood loss was 105.3±57.8 ml. Postoperative hospital stay was 7.3±2.4 days.Diagnostic accuracy was 99.7%. Incidence of complication was 0.5%. Five（1.5%） patients were converted to thoracotomy and no perioperative death occurred. Conclusions Age, diameter, glitches, lobulation, traction of pleural are independent predictors of malignancy in the patients with SPN. VATS is a safe and efficient method for diagnosis and treatment of SPN.

关 键 词：孤立性肺结节 电视胸腔镜手术 肺癌 诊断 治疗 

分 类 号：R734.2[医药卫生—肿瘤]