肺部同时性多发磨玻璃结节56例临床分析  

Clinical analysis of 56 cases of simultaneous multiple ground glass nodule in the lung

作　　者：刘广杰[1] 巨建梅 张静静[1] 解少男 高茂刚 刘芳[1] 刘庆熠[1] LIU Guangjie;JU Jianmei;ZHANG Jingjing;XIE Shaonan;GAO Maogang;LIU Fang;LIU Qingyi(Department of Thoracic Surgery, the No. 4th Hospital of HeBei Medical University, Shijiazhuang 050011, China)

机构地区：[1]河北医科大学第四医院胸外科,石家庄050011

出　　处：《临床肿瘤学杂志》2020年第5期456-460,共5页Chinese Clinical Oncology

基　　金：2019年省自然科学基金项目(H2019206465);河北省卫健委医学科学研究课题计划(20160637,20190682)。

摘　　要：目的分析肺部同时性多发磨玻璃结节(GGN)患者的诊治过程,以期为临床提供参考。方法对河北医科大学第四医院胸外科2015年5月至2018年12月收治的56例同时性多发GGN患者行胸部高分辨CT检查,根据影像学资料分析GGN病灶个数、位置和形态并确定主导病灶和非主导病灶。利用设定策略对病灶进行CT引导下肺穿刺活检,根据穿刺病理结果制定手术方案。结果56例肺部同时性GGN患者共发现144个GGN,其中主导病灶60个,非主导病灶84个。CT引导下穿刺25例(单侧15例和双侧10例),穿刺病理示:恶性32例(腺癌20例和伏壁状肿瘤12例)、良性3例。47例行手术治疗,主导病灶和非主导病灶切除率分别为83.33%(50/60)和41.67%(35/84),病理检查示:浸润性腺癌47个、微浸润腺癌16个、原位癌11个、非典型腺瘤样增生7个和良性4个,仍随访结节59个。所有患者顺利出院,随访2~43个月,均健康生存。结论肺部同时性GGN术前应根据影像学资料和CT穿刺病理结果制定合适的手术策略,外科手术治疗效果良好。Objective To analyze the diagnosis and therapy process of patients with synchronous multiple ground-glass nodule(GGN)and provide diagnosis and treatment experience for the clinic.Methods Pulmonary high resolution CT scan was performed on 56 patients with synchronous multiple GGN admitted to the Department of Thoracic Surgery of the No.4th Hospital of HeBei Medical University from May 2015 to December 2018.The number,location and shape of all the GGN were described based on imaging data.Dominant and non-dominant lesions were marked according to the CT images.CT-guided lung puncture biopsy was performed according to the established strategy,and surgical plan was made based on the puncture pathological results.Results A total of 144 GGN,including 60 dominant and 84 non-dominant lesions,were detected in the 56 patients.CT-guided puncture was performed in 25 cases(15 unilateral and 10 bilateral).Pathological examination showed that 32 cases were malignant(20 cases of adenocarcinoma and 12 cases of mural tumor)and 3 cases were benign.Forty-seven cases were treated by operation.The resection rates of dominant and non-dominant lesions were 83.33%(50/60)and 41.67%(35/84),respectively.Pathological examination showed that there were 47 lesions of invasive adenocarcinoma,16 lesions of microinvasive adenocarcinoma,11 lesions of carcinoma in situ,7 lesions of atypical adenomatous hyperplasia and 4 benign lesions.Fifty-nine nodules were still followed up.All patients were discharged from hospital and were all in good health after being followed up from 2 to 43 months.Conclusion Appropriate surgical strategies for snchronous multiple GGNs based on imaging data and CT-guided lung puncture biopsy are recommended and surgical resection is a preferable choice.

关 键 词：肺癌 同时性 多发磨玻璃结节 CT引导下穿刺 手术策略 

分 类 号：R734.2[医药卫生—肿瘤]