亚厘米肺结节的外科诊疗分析  

Clinical Diagnosis and Surgical Treatment of Sub-centimeter Solitary Pulmonary Nodules

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

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

出　　处：《中国微创外科杂志》2017年第1期11-14,共4页Chinese Journal of Minimally Invasive Surgery

基　　金：北京市自然科学基金(7132106);973国家科技计划课题(2011CB510100)

摘　　要：目的探讨亚厘米(<10 mm)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~2015年12月手术治疗62例亚厘米SPN进行回顾性分析。术前均行多次胸部CT扫描随访,随访观察时间3~72个月(平均6.8月)。术前胸部CT肺窗测定病变大小,直径≤5 mm 28例,6~9 mm 34例。实性结节17例,半实性结节36例,纯磨玻璃样病变9例。其中56例行术前病变定位。术式包括胸腔镜单纯病变切除或剔除术2例,肺楔形切除术47例,肺段切除术8例,肺叶切除术5例。结果术后病理证实恶性结节54例(87.1%),包括非典型性腺瘤样增生(atypical adenomatous hyperplasia,AAH)和原发恶性肿瘤共49例,转移瘤5例;良性结节8例(12.9%)。结论亚厘米SPN影像学静态特征相对缺乏,需要通过其实质变化及动态观察确定诊疗策略。影像学定位技术有助于胸腔镜术中准确定位,肺叶和亚肺叶切除对亚厘米SPN的诊疗安全有效。Objective To investigate the clinical diagnosis and surgical treatment of sub-centimeter solitary pulmonary nodule（ SPN）. Methods A retrospective analysis was performed on 62 patients with sub-centimeter SPN receiving resection in our hospital from January 2006 to December 2015. All the patients underwent repeatedly preoperative chest CT scans,and were followed up for 3-72 months（ mean,6. 8 months）. According to the preoperative chest CT lung window,the diameter of the lesion was less than 5 mm in 28 cases and 6-9 mm in 34 cases. There were 17 cases of solid nodules,36 cases of semi solid nodules,and 9 cases of pure grinding glass like lesions. Of these 56 underwent preoperative lesion location. Surgical methods included thoracoscopic lesion resection or eliminate surgery in 2 cases,pulmonary wedge resection in 47 cases,pulmonary segmentectomy in 8 cases,and lobectomy in 5cases. Results Postoperative pathological examination confirmed malignant nodules in 54 cases（ 87. 1%）,including 49 cases of atypical adenomatous hyperplasia and primary malignant tumors and 5 cases of metastatic tumors. Benign nodules were seen in 8 cases（ 12. 9%）. Conclusions The sub-centimeter SPN imaging relatively lacks of static characteristics,so its substantial changes and dynamic observations are needed to determine diagnosis and treatment strategy. Imaging location technique helps thoracoscopic surgery of accurate positioning. Lobectomy and sublobar resection are safe and effective methods for patients with sub-centimeter SPN.

关 键 词：亚厘米肺结节 胸腔镜手术 诊断 治疗 

分 类 号：R734.2[医药卫生—肿瘤]