Guideline on Management of Solitary Pulmonary Nodule

The aim of the proposed recommendations is to be a tool to facilitate decision-making in patients with a solitary pulmonary nodule (SPN). For an optimal decision, accessibility to the different diagnostics techniques and patient preferences need to be incorporated.The first assessment, which includes a chest computed tomography scan, separates a group of patients with extrapulmonary neoplasm or a high surgical risk who require individualized management. Another two groups of patients are patients with SPN up to 8 mm and those who have a subsolid SPN, for which specific recommendations are established.SPNs larger than 8 mm are classified according to their probability of malignancy into low (less than 5%), where observation is recommended, high (higher than 65%), which are managed with a presumptive diagnosis of localized stage carcinoma, and intermediate, where positron emission tomography-computed tomography has high yield for reclassifying them into high or low probability. In cases of intermediate or high probability of malignancy, transbronchial needle aspiration or biopsy of the nodule may be an option.Radiologic observation with low radiation computed tomography without contrast is recommended in SPN with low probability of malignancy, and resection with videothoracoscopy in undiagnosed cases with intermediate or high probability of malignancy.     

电视辅助胸腔镜手术治疗孤立性肺结节临床效果研究

目的探讨电视辅助胸腔镜手术治疗孤立性肺结节临床效果。方法回顾性分析2012年1月~2013年3月我院手术治疗的60例孤立性肺结节患者的临床资料,其中40例患者行VATS手术(VATS组),20例患者行传统开胸手术(开胸组)。比较两组患者孤立性肺结节病理性质、术中出血量、手术时间、胸管留置时间、胸腔引流量、住院时间、住院总费用及术后并发症率。结果两组患者孤立性肺结节的病理特征比较无统计学差异(χ2=6.3442,P=0.5002)。VATS组患者术中出血量、胸腔引流量明显少于开胸组(P0.01或P0.05),手术时间、胸管留置时间及住院时间明显短于开胸组(P0.01),住院总费用与开胸组比较无统计学差异(P0.05)。两组术后并发症发生率比较差异无统计学意义(χ2=3.5337,P=0.0601)。结论电视辅助胸腔镜手术治疗孤立性肺结节损伤小,患者恢复快,效果确切,值得临床推广应用。     

孤立性肺结节良恶性病变的危险因素分析

目的分析孤立性肺结节（直径≤3cm）良恶性病变的危险因素，并探讨其诊断和治疗。方法回顾性分析2001年1月至2002年12月在我院接受手术治疗的297例孤立性肺结节患者的临床资料，对年龄、性别、吸烟指数、有无临床症状、病变部位、结节大小和影像学表现等因素与孤立性肺结节良恶性的关系采用x^2检验或t检验进行单因素分析，采用logistic回归进行多因素分析。结果单因素分析结果表明，年龄（P=0．000）、吸烟指数（P=0．001）、结节大小（P=0．000）、影像学表现（P=0．000）与结节病变的良恶性均有明显的关系。logistic回归多因素分析显示患者年龄（OR值=1．096）、结节大小（OR值=2．329）和结节的影像学表现（OR值=0．167）与孤立性肺结节的良恶性显著相关。结论患者的年龄和结节大小可作为评估孤立性肺结节良恶性病变的危险因素，影像学检查也有助于孤立性肺结节良恶性的鉴别诊断。     

孤立性肺结节的良恶性鉴别诊断进展

孤立性肺结节（solitary pulmonary nodule,SPN）是指直径〈30 mm的肺内结节,多于体检或因其他疾病在医院检查时发现,患者无其他肺部病变相对应的症状和体征,因而早期很难确定其性质。SPN存在一定的恶性概率,早期诊断成为影响预后的关键,如何鉴别其良恶性是临床诊治的难题之一。仅仅根据SPN的大小、特征,难以作出准确的判断。近年来,随着新型纤维支气管镜、高分辨率CT、胸腔镜技术的发展,为临床上鉴别SPN的良恶性提供了帮助,现对SPN鉴别诊断方面的进展进行综述。     

胸腔镜手术在孤立性肺结节诊断和治疗中的应用

目的探讨胸腔镜手术在孤立性肺结节诊断和治疗中的价值。方法1994年5月～2009年11月,经胸片、胸部CT发现的周围型孤立性肺结节(直径≤3cm)115例,术前均无明确病理诊断,经胸腔镜手术局部切除,术中送快速冰冻病理检查,根据病理结果和病人情况决定手术方式。原发性肺癌行全胸腔镜或胸腔镜辅助小切口肺叶切除、淋巴结清扫40例;行肺楔形切除75例,其中良性肿瘤59例、转移癌11例、不适合肺叶切除的原发性肺癌5例。结果所有病人均明确病理诊断,确诊率100%。术中、术后并发症10例(8.7%,10/115):全胸腔镜肺叶切除术中肺动脉分支出血1例,转小切口开胸止血;胸引管拔除超过1周3例,呼吸功能不全3例,肺不张、胸腔积液、切口感染各1例,经对症治疗治愈。无严重手术并发症,无手术死亡。良性肿瘤59例随访2～176个月,平均44.5月,无复发。原发性肺癌行全胸腔镜肺叶切除、淋巴结清扫18例,随访3～24个月,平均11个月,1例24个月复发仍存活,其余无复发。结论胸腔镜手术在明确孤立性肺结节病理诊断方面有不可取代的重要作用。良性孤立性肺结节得到治愈,原发肺癌可以得到明确诊断,及时有效的治疗,微创效果显著。     

The Availability of Pre- and Intraoperative Evaluation of a Solitary Pulmonary Nodule in Breast Cancer Patients

Purpose: It is clinically difficult to differentiate between primary lung cancer (PLC) and metastasis from breast cancer (MBC) in the diagnosis of a solitary pulmonary nodule (SPN) observed in a patient with past history of breast cancer. We evaluated several clinical, radiological and pathological variables in patients with SPN in an attempt to identify reliable markers to differentiate them.Methods: Retrospectively we reviewed the clinical, radiological and pathological characteristics of 64 patients with a history of breast cancer resection who subsequently underwent surgical resection of an indeterminate SPN in our institute.Results: The patients with MBC were significantly younger (p = 0.01). Among CT findings, presence of a solid opacity (p <0.01), well-defined tumor (p <0.01) and absence of an air bronchogram (p <0.01) were significantly associated with MBC. Among the intraoperative frozen section pathologic findings, the absence of lepidic or papillary patterns (p <0.01) and the presence of strong fibrosis in the tumor (p <0.01) were significantly correlated with MBC.Conclusion: Although some cases are difficult to confirm the definitive diagnoses of SPN, combining CT and intraoperative pathological findings might enable us to distinguish SPN between MBC and PLC prior to postoperative examinations.