胸腔镜治疗≤10 mm非小细胞肺癌的临床研究

背景与目的早期原发性非小细胞肺癌（non-small cell lung cancer, NSCLC）的手术切除及淋巴结切除的合理方式存在较大争议，本研究旨在探讨直径≤10 mm的原发NSCLC的微创切除及淋巴结切除的手术方式。方法对2013年7月-2016年3月在我院接受电视胸腔镜手术（video-assisted thoracic surgery, VATS）治疗并有明确病理诊断为NSCLC的共46例患者的临床资料进行回顾性分析。所有患者术前行薄层计算机断层扫描（computed tomography, CT），实性结节5例，混合性磨玻璃结节（mixed ground-glass opacity, mGGO）23例，纯磨玻璃结节（pure ground-glass opacity, pGGO）18例。根据患者具体情况采用不同术式，包括VATS肺叶切除和系统性淋巴结清扫，VATS肺楔形切除和选择性淋巴结切除，VATS肺段切除和选择性淋巴结切除，或仅采用VATS肺楔形切除。其中7例术前行CT引导下Hook-wire定位。结果 VATS肺叶切除和系统性淋巴结清扫23例（mGGOs 15例，pGGOs 4例，实性结节4例），只有1例实性腺癌结节出现N2淋巴结转移，VATS肺楔形切除和选择性淋巴结切除5例（mGGOs 2例，pGGOs 3例）和VATS肺段切除和选择性淋巴结切除4例（mGGOs 2例，pGGOs 2例）均无淋巴结转移，仅采用VATS肺楔形切除14例（mGGOs 4例，pGGOs 9例，实性结节1例）。7例Hook-wire定位均成功。围手术期无重大并发症，随访1个月-26个月，平均（13.7±8.7）个月，无复发及转移。结论直径≤10 mm以mGGO和pGGO为表现的原发性NSCLC淋巴结转移率低，术中可以不进行淋巴结的清扫，实性结节应选择性淋巴结切除或系统性淋巴结清扫。高龄和心肺功能差的患者可以选择楔形切除或肺段切除。术前运用Hook-wire定位安全有效，可为VATS提供便利。

Clinical Study of Surgical Treatment of Non-small Cell Lung Cancer 10 mm or Less in Diameter Under Video-assisted Thoracoscopy

Background and objective hTe reasonable operational manner of non-small cell lung cancer (NSCLC) in early stage is in dispute. hTis clinical study is to investigate the operational manner of NSCLC 10 mm or less in diameter. Methods hTe clinical datas of 46 cases with NSCLC 10 mm or less in diameter were retrospectively analyzed in our hospital from July 2013 to March 2016. hTin-section computed tomography (CT) was done on all cases with 46 pulmonary nodules (5 solid nodules, 23 mGGOs and 18 pGGOs). Lobectomy, wedge resection and segmentectomy with lymph node dissection may be performed in patients according to age or heart and lung function. CT-guided Hook-wire precise localization was done on 7 cases. Results Lobectomy and systematic lymph node dissection under video-assisted thoracic surgery (VATS) were performed in patients with 23 pulmonary nodules (15 mGGOs, 4 pGGOs and 4 solid nodules ), among wich, only one patient with N2 lymph node matastasis was found. Wedge resection and selective lymph node dissection under VATS were done in patients with 5 pulmonary nodules (2 mGGOs and 3 pGGOs), and segmentectomy and selective lymph node dissection un-der VATS were done in patients with 4 pulmonary nodules (2 mGGOs and 2 pGGOs), among wich, no patient with lymph node matastasis was found. CT-guided Hook-wire precise localization was done successfully on 7 cases. Conclusion Usually NSCLC with pGGO and mGGO nodules 10 mm or less in diameter has no lymph node metastasis, therefore, systematic lymph node dissection may be not necessary. Selective lymph node dissection or systematic lymph node dissection should be performed in patients with solid nodules 10 mm or less in diameter. Wedge resection and segmentectomy may be performed in patients with advanced age or lower heart and lung function. hTe preoperative CT-guided Hook-wire localization for pulmo-nary nodules particularly for GGOs is an effective and safe technique to assist VATS resection of the GGOs.