临床鉴别困难的肺内多发实性病灶的外科治疗分析  

Surgical resection for synchronous multiple pulmonary nodules identified difficultly in clinics

作　　者：杨德松 王文祥 周勇 李旭 张百华 吴劼 吴智宁 唐金明 YANG Desong;WANG Wenxiang;ZHOU Yong;LI Xu;ZHANG Baihua;WU Jie;WU Zhining;TANG Jinming(Department of Thoracic Surgery,The Affiliated Cancer Hospital of Xiangya School of Medicine,Central South University/Hunan Cancer Hospital,Hunan Clinical Medical Research Center of Accurate Diagnosis and Treatment for Esophageal Carcinoma,Changsha,410013,P.R.China)

机构地区：[1]湖南省肿瘤医院/中南大学湘雅医学院附属肿瘤医院胸部肿瘤外科中心湖南省食管肿瘤精准诊疗临床医学研究中心,长沙410013

出　　处：《中国胸心血管外科临床杂志》2022年第5期607-612,共6页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：湖南省卫健委科研计划课题(202204022569);湖南省肿瘤医院2020年度科研攀登计划重大专项(ZX2020005);湖南省食管肿瘤精准诊疗临床医学研究中心(2020SK4005)。

摘　　要：目的探讨临床鉴别困难的肺内多发实性病灶的临床病理特征及外科处理前景。方法回顾性分析2012—2019年湖南省肿瘤医院胸部肿瘤外科中心二区连续完成的临床鉴别困难的肺内多发实性病灶行手术治疗97例患者的临床资料,其中男72例、女25例,年龄(58.1±9.0)岁。其中病灶位于一侧78例、双侧19例,分析主病灶与次病灶的临床病理特征及多发实性病灶外科处理的围术期风险。结果同侧及双侧病灶患者均同期完成手术,手术顺利。主病灶以肺叶切除为主(71.1%),电视胸腔镜手术(video-assisted thoracoscopic surgery,VATS)完成率69.1%(67/97)。次病灶以楔形切除为主(80.4%),VATS完成率71.1%(69/97)。单侧或双侧手术后3级以上并发症发生率为12.8%及5.3%。术后病理证实主病灶恶性65例(67.0%),以腺癌为主(63.1%),其中Ⅰ期43.1%;良性32例,以结核瘤为主(56.3%)。次病灶恶性29例,良性67例,良恶性均有1例。主次病灶的病理一致率为54.6%[肺癌肺内转移及均为良性者(含不同类型良性病灶者)]。主病灶为恶性时,其直径在<3 cm、3~<5 cm、5~7 cm、>7 cm时,次病灶为转移瘤的比率依次为42.5%、15.8%、20.0%、0。主病灶为恶性且伴有淋巴结转移时,次病灶为转移灶的几率有高于不伴淋巴结转移者的趋势(46.7%vs.30.0%,P>0.05)。当主病灶为恶性,主次病灶位于同叶时,次病灶转移可能性大(54.5%),而位于同侧不同叶及不同侧时,次病灶为良性可能性大(58.1%、72.7%),转移可能性小(32.6%、9.1%);当主病灶为良性,临床鉴别诊断困难时,次病灶均为良性。结论鉴别诊断困难的肺内多发实性病灶,主病灶直径越大,次病灶为转移瘤的比率有降低趋势;主次病灶位于同叶和/或伴淋巴结转移者,次病灶为转移可能性大;次病灶位于对侧时转移的可能性小;双侧同期手术不明显增加手术风险。Objective To evaluate the role of surgical resection on synchronous multiple pulmonary nodules identified difficultly in clinics.Methods The clinical data of 97 patients with synchronous multiple pulmonary nodules who received surgical resection between 2012 and 2019 in Hunan Cancer Hospital were retrospectively analyzed.There were 72 males and 25 females,aged 58.1±9.0 years.Among these patients,there were 78 patients with ipsilateral and 19patients with bilateral pulmonary nodules.Clinicopathological parameters between main nodules and secondary nodules were evaluated.Perioperative morbidity was also assessed.Results The operation was successfully completed on all patients for the ipsilateral and bilateral lesions.Totally,71.1%of mian lesions was mostly removed by lobectomy,and the completion rate of video-assisted thoracoscopic surgery(VATS)was 69.1%(67/97);80.4%of secondary lesions were mostly removed by wedge resection,and the completion rate of VATS was 71.1%(69/97).The incidence of grade 3 or higher complications after unilateral or bilateral surgery was 12.8%and 5.3%,respectively.Postoperative pathology confirmed that the main lesions were malignant in 65 patients(67.0%),mainly adenocarcinoma(63.1%),of which 43.1%were in the stageⅠ;32 patients were benign,mainly tuberculoma(56.3%).There were 29 patients of malignant secondary lesions,67 benign,and 1 both benign and malignant;the pathological agreement rate of primary and secondary lesions was 54.6%(lung cancer metastases in the lung and all the benign).When the primary lesion was malignant with its diameters of<3 cm,3-<5 cm,5-7 cm,>7 cm,the metastatic rate of secondary lesions was 42.5%,15.8%,20.0%,0,respectively.When the primary lesion was malignant with lymph node metastasis,the probability of the secondary lesion being a metastatic tumor was higher than that without lymph node metastasis(46.7%vs.30.0%,P>0.05).When the primary lesion was malignant and the primary and secondary lesions were located in the same lobe,the secondary lesions were more likel

关 键 词：肺癌 多发实性病灶 手术 

分 类 号：R734.2[医药卫生—肿瘤]