胸腔镜下同期手术治疗多发肺磨玻璃结节的疗效观察  

The clinical study of simultaneous thoracoscopic surgery for multiple pulmonary ground glass nodules

作　　者：陶毅 曹炜[1] Tao Yi

机构地区：[1]安徽医科大学第二附属医院,230601 [2]安徽省淮南市寿县县医院,232200

出　　处：《浙江临床医学》2022年第6期835-836,840,共3页Zhejiang Clinical Medical Journal

摘　　要：目的探讨肺部多发磨玻璃结节(GGN)的病理类型及胸腔镜下肺部多发GGN同期外科手术治疗的效果。方法根据胸部薄层CT评估主要病灶是否含有实性成分将手术切除的98枚肺部多发GGN患者分为肺部纯磨玻璃结节(pGGN)组与肺部混合磨玻璃结节(mGGN)组,观察并记录两组的临床资料、病理类型情况,分析单侧手术组及双侧手术组的手术相关数据、术后随访情况,进一步评价临床治疗效果。结果所有手术均顺利完成,无中转开胸病例,术后2例肺持续性漏气>3 d,患者均痊愈出院。共切除GGN98枚,总恶性率87.7%。其中,pGGN66枚,恶性率为92.8%;mGGN32枚,恶性率为75%。pGGN多为原位腺癌(72.7%),mGGN多为微浸润性腺癌(37.5%),mGGN组术后病理结果与pGGN组比较,差异有统计学意义(P<0.01)。肺部mGGN患者行同期双侧手术治疗,未出现严重并发症。双侧手术组的术中出血量、胸引管留置时间、术后住院时间均略高于单侧手术组,但差异无统计学意义(P>0.05)。结论肺部GGN患者病灶为恶性可能性大,mGGN术后病理结果相较于pGGN恶性程度更高,通过严格术前评估、合理术前规划后可考虑行胸腔镜下同期外科手术治疗,安全性、可行性均较高,临床治疗效果满意。Objective To explore the pathological types of multiple ground glass nodules(GGN)of lung and the clinical experience of simultaneous surgical treatment of multiple GGN under video-assisted thoracoscopy.Methods 98 cases of pulmonary GGN were divided into pulmonary pure ground glass nodules(pGGN)group and pulmonary mixed ground glass nodule(mGGN)group according to thin slice chest CT to evaluate whether the main lesions contained solid components.The clinical data and pathological types of the two groups were observed and recorded.The operation-related data and postoperative follow-up of unilateral operation group and bilateral operation group were recorded and analyzed to further evaluate the clinical treatment effect.Results All operations were completed successfully and there was no case of conversion to thoracotomy,with 2 cases of persistent lung leakage>3 days after operation,all patients were cured and discharged from hospital,and there was no death.A total of 98 GGN were excised,and the total malignant rate was 87.7%.Among them,the malignant rate of 66 pGGN was 92.8%,the malignant rate of 32 mGGN was 75%.Most of pGGN was adenocarcinoma in situ(72.7%),and most of mGGN was microinvasive adenocarcinoma(37.5%).There was significant difference in postoperative pathological results between mGGN group and pGGN group(P<0.05).Patients with mGGN of the lung were treated with bilateral operation at the same time,and there were no serious complications.The intraoperative blood loss,indwelling time of chest catheter and postoperative hospital stay in the bilateral operation group were only slightly higher than those in the unilateral operation group,and the difference was not statistically significant(P>0.05).Conclusion Patients with GGN of the lung are more likely to be malignant,and the rates of malignant pathological results after mGGN are higher than those of pGGN.Video-assisted thoracoscopic surgery can be considered after strict preoperative evaluation and reasonable preoperative planning,which is safe and feasible

关 键 词：多发肺磨玻璃结节 同期手术 胸腔镜手术 

分 类 号：R73[医药卫生—肿瘤]