肺磨玻璃结节的外科诊断和治疗分析——附663例报告

发布时间：2018-08-12 12:06

【摘要】：目的总结分析肺CT检查发现的磨玻璃结节(GGO)的外科诊断和治疗特点。方法回顾性纳入2013年1月至2016年12月在四川大学华西医院胸外科行手术切除治疗的肺GGO患者,总结其手术前、手术中以及手术后的临床资料,分析GGO的外科诊治特点。结果共纳入663例患者,手术后病理证实为恶性病变者614例,恶性比例为92.6%。良性GGO组病变直径小于恶性GGO组[(0.8±0.2)cm vs.(1.5±0.8)cm,P0.001]。恶性GGO组患者在胸部CT出现边界不清征象的比例高于良性GGO组(93.8%vs.20.4%,P0.001),而两组患者在空泡征、胸膜牵拉、毛刺和分叶征象上差异无统计学意义(P0.05)。652例(98.3%)患者行胸腔镜手术,仅11例(1.7%)患者行开放手术。336例(50.7%)患者行肺叶切除术,226例(34.1%)患者行肺段切除术,101例(15.2%)患者接受肺楔形切除术。共60例(9.0%)患者发生术后并发症,1例(0.2%)患者死亡。结论由经验丰富的医生筛选的GGO病例,恶性病变比例高,可结合患者的病史资料、影像学资料、年龄、身体状况和心理等情况决定是否行手术切除。手术以微创为主,行亚肺叶或肺叶切除,患者可获得良好的治疗效果。
[Abstract]:Objective to summarize and analyze the surgical diagnosis and treatment of ground-glass nodules (GGO) found by CT. Methods from January 2013 to December 2016, lung GGO patients who were treated by thoracic surgery in Huaxi Hospital of Sichuan University were retrospectively included. The clinical data before, during and after operation were summarized, and the characteristics of surgical diagnosis and treatment of GGO were analyzed. Results 663 cases were included, 614 cases were proved malignant after operation and pathology, the malignant ratio was 92.6%. The diameter of benign GGO was smaller than that of malignant GGO [(0.8 卤0.2) cm vs. (1.5 卤0.8) cm P0.001]. The incidence of borderline signs in malignant GGO group was higher than that in benign GGO group (93.8vs.20.4P0.001), but there was no significant difference in vacuole sign, pleural traction, prickles and lobular signs between the two groups (P0.05) .652 cases (98.3%) underwent thoracoscopic surgery. Only 11 cases (1.7%) underwent open surgery. 336 cases (50.7%) underwent lobectomy, 226 cases (34.1%) underwent segmental resection and 101 cases (15.2%) received wedge resection. A total of 60 (9. 0%) patients died of postoperative complications (0. 2%). Conclusion the GGO cases screened by experienced doctors have a high proportion of malignant lesions, which can be combined with the patient's history, imaging data, age, physical condition and psychology to decide whether or not to be excised. Minimally invasive surgery, subpulmonary lobectomy or lobectomy, patients can obtain good results.
【作者单位】：四川大学华西医院胸外科;四川大学华西医院呼吸与危重症医学科;
【基金】：四川省卫生和计划生育委员会项目(No.16PJ292) 四川省科技厅科技支撑计划项目(No.2014SZ0148,No.2016FZ0118)资助
【分类号】：R655.3

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