电视胸腔镜技术在孤立性肺结节诊治中的应用

目的探讨电视胸腔镜（VATS）在孤立性肺部结节（SPN）诊治中的应用价值。方法 55例SPN患者,先在VATS下探查定位,然后行肺叶楔形切除并送快速冰冻病理检查;若为良性,则结束手术;若为恶性则在VATS辅助下行小切口肺叶切除加纵隔淋巴结清扫术。结果本组31例为良性病变,24例为恶性病变;30例行VATS下肺楔形切除,25例行VATS辅助小切口肺叶切除加纵隔淋巴结清扫。均无围手术期死亡,未出现严重手术并发症。结论 VATS在SPN诊治中有重要应用价值,有利于SPN的准确诊断和规范治疗,应做为SPN主要或标准的诊治手段加以明确。     

常规胸腔镜与单操作孔胸腔镜手术治疗老年孤立性肺结节对比分析

肺癌是全球最常见、最主要的恶性肿瘤之一。据统计,近五十多年来,世界各国特别是工业发达国家,肺癌的发病率和病死率均迅速上升,目前居全世界癌症死因第1名。中国肺癌发病率及患病绝对人数均占全世界的第1位。目前,手术切除是肺癌最有效的治疗手段。然而,现实中老年患者因心肺功能储备差,不能耐受传统开胸肺叶切除,不得不放弃手术治疗。随着血管和气管成形技术的成熟,特别是胸腔镜技术的日益成熟,相对扩大了此类患者的手术适应证。     

胸腔镜手术在孤立性肺结节诊断和治疗的应用

影像学上直径小于3cm的不伴有肺不张或肺门淋巴结肿大的单发肺实质病灶称为孤立性肺结节（solitary pulmonary nodule，SPN）^[1]，准确及时地明确SPN的诊断尤其是良恶性的鉴别诊断，是临床医生所面临的难点与关键。自1996年2月深圳市人民医院胸外科在国内较早开展电视胸腔镜手术（video assisted thoracoscopic surgery，VATS）用于胸部外科疾病的诊治。现就VATS在SPN诊疗中的应用报告如下。     

胸腔镜手术治疗孤立性肺结节58例临床分析

采用胸腔镜手术治疗孤立性肺结节58例。根据结节位置,于腋下第4或第5肋间做4～5cm小切口,切开肋间肌进入胸腔,若结节为原发性肺癌,则将小切口适当延长至7—9cm,以便行肺叶切除及区域淋巴结清扫。手术顺利,无手术死亡及胸腔感染、大出血者。认为胸腔镜手术治疗孤立性肺结节具有切口小、并发症少的优点。     

电视胸腔镜在肺部疾病诊治中的应用

电视胸腔镜是一种安全，损伤性小的新技术。本综述了电视胸腔镜在弥漫性肺部疾病，肺部肿瘤，自发性气胸等疾病中的诊断，治疗进展。     

电视胸腔镜在肺部疾病诊治中的应用

电视胸腔镜是一种安全,损伤性小的新技术。本文综述了电视胸腔镜在弥漫性肺部疾病.肺部肿瘤,自发性气胸等疾病中的诊断、治疗进展。     

电视胸腔镜肺活检

电视胸腔镜外科是一项不经常规开胸切口就能对胸内器官进行手术损伤的技术。我们用此项技术为１１名病人进行了肺活检术，所有病人的术后疼痛均显著减轻，均大一周内恢复出院。除了开胸手术和传统胸腔镜技术，电视胸腔镜外科技术又为我们提供了一个诊疗胸内疾病的手段。     

孤立性肺结节的临床分析

目的研究孤立性肺结节(SPN)的临床特征,探讨SPN诊断与治疗。方法胸腔镜手术治疗肺结节64例,分析年龄、性别、症状、吸烟史、肺内结节的影像学表现、手术情况、术后病理等因素。结果 SPN的恶性病变与吸烟史,肿瘤直径,肿瘤的边界,肿瘤钙化有关。64例患者中诊断为恶性病变36(56.25%)例。28(43.75%)例术中快速病理诊断为良性病变,其中错构瘤4例,结核球14例,炎性假瘤10例。结论 SPN的良恶性与吸烟史,结节大小,肿瘤边界,是否钙化有关;胸腔镜手术有助于SPN病理诊断与治疗。     

电视胸腔镜在肺外科的应用

1991年 Akabayashi和 Natbanson等报道电视胸腔镜下行肺大泡切除和恶性胸水治疗。以后 ,电视胸腔镜手术( VATS)得到了广泛应用 ,许多过去认为腔镜难以完成的治疗现在均能完成。本文介绍胸腔镜在肺外科的应用。1　肺活检术肺间质纤维化、肺弥漫性坏死性肉芽肿病、肺淀粉样变性、特发性含铁血黄素沉着症、纤维性肺泡炎和弥漫性肺泡细胞癌等一直是诊断上难点 ,以往的确诊方法有纤维支气管镜活检、经纤维支气管镜肺灌洗脱落细胞检查及肺穿刺活检 ,常常因为活检组织标本太小或脱落细胞数量太少而不能获得明确的诊断。开胸活检的创伤大 ,而且术…     

Hookwire定位下单孔胸腔镜切除孤立性肺小结节63例报告

目的探讨Hookwire定位下单孔胸腔镜切除孤立性肺小结节的临床疗效。方法选取近期来我科收治的63例孤立性肺小结节患者作为观察对象,所有患者术前均在CT引导下留置Hookwire定位针,转至手术室在单孔胸腔镜下进行切除,并依据术中冰冻结果决定下一步手术方案。结果所有患者在CT引导下均成功行Hookwire定位,无严重定位并发症发生,转手术室均成功行单孔胸腔镜手术治疗,无中转开胸,均为一次性将结节切除。26例行VATS肺叶切除加淋巴结清扫术,术后石蜡病理结果与术中冰冻结果完全相符。结论孤立性肺小结节单孔胸腔镜手术前通过Hookwire穿刺定位,具有定位准确率高、疗效可靠、并发症少等特点,在临床上具有较高的应用价值。     

Evaluation of the solitary pulmonary nodule

The solitary pulmonary nodule represents a common diagnostic challenge for clinicians. While most are benign, a significant number represent early, potentially curable lung cancers. With the increased utilisation of chest computed tomography, solitary pulmonary nodules are increasingly being identified and with lung cancer screening programmes now on the horizon globally, it is crucial clinicians are familiar with the evaluation and management of solitary pulmonary nodules. Through the evaluation of patient risk factors combined with computed tomography characteristics of solitary pulmonary nodules, including size, growth rate, margin characteristics, calcification, density and location; a clinician can assess the risk of malignancy. This article provides an up to date review of the imaging features of both benign and malignant solitary pulmonary nodules to assist in the identification of nodules that require histological confirmation or ongoing surveillance. In addition, we summarise the newly updated Fleischner Society Guidelines that provide clinicians with a framework for the evaluation and management of solitary pulmonary nodules.     

Chronic solitary pulmonary nodule due to unsuspected pulmonary infarction from silent pulmonary embolism

Abstract A case of pulmonary embolism showing a longstanding solitary pulmonary nodule is presented. An asymptomatic 57 year-old man with a solitary nodule in the right lower lobe was referred to our hospital. A pulmonary perfusion-ventilation scan following a sudden onset of dyspnoea established the diagnosis of recurrent pulmonary embolism. The nodule gradually disappeared after anticoagulant treatment, indicating that the nodule was pulmonary infarction from silent pulmonary embolism. Although the incidence of pulmonary infarction is low in Japan, this case suggests that pulmonary infarction from silent pulmonary embolism should be considered as one important cause of a solitary pulmonary nodule.     

Technologies for targeting the peripheral pulmonary nodule including robotics

Bronchoscopic sampling of PPL was significantly advanced by the development of the endobronchial ultrasound guide sheath method in the 1990s. Since then, a range of technical and procedural techniques have further advanced diagnostic yields. These include the use of thinner bronchoscopes with better working channel diameters, understanding the importance of peripheral transbronchial needle aspiration, and virtual bronchoscopic assistance. These have enabled better sampling of smaller and more technically challenging lesions including ground‐glass nodules. Most recently, robotic bronchoscopy has been developed which, among other refinements, allows fine control of visual bronchoscopic navigation by replacing movements directed by the hand with electronic consoles and trackballs, and innovatively integrate virtual with real bronchoscopic pathways. The requirement for PPL diagnosis and treatment is expected to increase with more chest CT performed as part of CT screening programmes.     

孤立性肺结节病变性质临床鉴别诊断预测模型的初探

目的探讨孤立性肺结节的良恶性鉴别诊断的有效方法。方法回顾性分析44例孤立性肺结节患者的临床特点,血清学指标及其鉴别诊断效果,并建立临床预测模型。结果44例肺内孤立性结节患者中,恶性肿瘤占19例,良性肿瘤占25例。单因素分析结果患者的年龄、结节大小、结节边界、肿瘤病史、CEA、CA125及miR．21、miR-27b和miR-193b在良恶性孤立性肺结节患者间具有显著差异,多因素判别分析并建立Fisher线性判别函数,交互验证一致函数与原始个案的符合率为93％。结论除患者的一般情况、影像学表现和常规血清标记物外,microRNAs也是鉴别孤立性肺结节良恶性的良好指标,具有重要临床意义。     

上海肺科医院110例肺部磨玻璃样结节临床诊治分析

目的观察肺部磨玻璃样结节(ground-glass nodule,GGN)的影像学特点、病理类型和手术效果。方法收集上海肺科医院因为GGN住院手术的完整病历110例。观察病人的性别、年龄、入院方式、平均住院时间、胸部X线片及胸部CT影像学特点、肿瘤标志物检查情况、气管镜检查情况、手术方式、病理类型分布、手术并发症等。结果 GGN(ground-glass nodule磨玻璃样结节)患者多无呼吸道症状和体征,肿瘤标志物检查阳性率低,气管镜检查阳性低,胸片检查漏诊率高,胸部CT可有效发现肺部隐蔽病灶,病理检查恶性率高,以腺癌为主,电视辅助胸腔镜手术创伤小,手术并发症少。结论胸部CT可作为常规体检项目,肺部高度疑癌磨玻璃样结节要尽早行电视辅助胸腔镜手术,以提高早期肺癌的治愈率。     

单操作孔电视胸腔根治术在治疗早期肺癌患者的有效性及安全性

目的研究单操作孔电视胸腔根治术在治疗早期肺癌患者的有效性及安全性。方法将2011年5月-2013年12月期间我院收治的早期肺癌患者90例纳入研究对象,根据手术方法不同分为进行单操作孔胸腔镜手术的单孔组、双操作孔胸腔镜手术的双孔组、肋间切口手术的开放组,比较三组患者的手术情况、并发症例数以及肺功能。结果单孔组患者的手术时间(1.84±0.22)h、术后卧床时间(4.21±0.54)d、住院总时间(9.62±1.04)d、术中出血量(142.7±18.2)ml、术后引流量(132.8±17.5)ml、疼痛NRS评分(2.12±0.34)、发生肺感染和肺不张(10%)均明显低于开放组和双孔组;PEF、FEV1/FVC%(76.2±9.6、65.8±8.5)均明显高于开放组和双孔组。结论单操作孔电视胸腔根治术有助于减小手术创伤、促进术后恢复、减少术后并发症、改善肺功能,是治疗早期肺癌安全且有效的手术方法。     

Precise characterization of a solitary pulmonary nodule using tumor shadow disappearance rate-corrected F-18 FDG PET and enhanced CT

We aimed to characterize solitary pulmonary nodule (SPN) using imaging parameters for F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) or enhanced CT corrected by tumor shadow disappearance rate (TDR) to reflect the tissue density.We enrolled 51 patients with an SPN who underwent PET/CT and chest CT with enhancement. The FDG uptake of SPN was evaluated using maximum standardized uptake value (SUVmax) on PET/CT. The mean Hounsfield unit (HU) for each SPN was evaluated over the region of interest on nonenhanced and enhanced CT images. The change in mean HU (HUpeak-pre) was quantified by subtracting the mean HU of the preenhanced CT from that of the post-enhanced CT. TDR was defined as the ratio of the tumor area, which disappears at a mediastinal window, to the tumor area of the lung window. We investigated which parameters (SUVmax or HUpeak-pre) could contribute to the characterization of SPN classified by TDR value and whether diagnostic performance could be improved using TDR-corrected imaging parameters.For SPN with higher tissue density (TDR <42%, n = 22), high value of SUVmax (≥3.1) was a significant factor to predict malignancy (P = .006). High value of HUpeak-pre (≥38) was a significant factor to characterize SPN (P = .002) with lower tissue density (TDR ≥42%, n = 29). The combined approach using TDR-corrected parameters had better predictive performance to characterize SPN than SUVmax only (P = .031).Applying imaging parameters such as SUVmax or HUpeak-pre in consideration of tissue density calculated with TDR could contribute to accurate characterization of SPN.     

Evidence based imaging strategies for solitary pulmonary nodule

Solitary pulmonary nodule (SPN) is defined as a rounded opacity ≤3 cm in diameter surrounded by lung parenchyma. The majority of smokers who undergo thin-section CT have SPNs, most of which are smaller than 7 mm. In the past, multiple follow-up examinations over a two-year period, including CT follow-up at 3, 6, 12, 18, and 24 months, were recommended when such nodules are detected incidentally. This policy increases radiation burden for the affected population. Nodule features such as shape, edge characteristics, cavitation, and location have not yet been found to be accurate for distinguishing benign from malignant nodules. When SPN is considered to be indeterminate in the initial exam, the risk factor of the patients should be evaluated, which includes patients’ age and smoking history. The 2005 Fleischner Society guideline stated that at least 99% of all nodules 4 mm or smaller are benign; when nodule is 5-9 mm in diameter, the best strategy is surveillance. The timing of these control examinations varies according to the nodule size (4-6, or 6-8 mm) and the type of patients, specifically at low or high risk of malignancy concerned. Noncalcified nodules larger than 8 mm diameter bear a substantial risk of malignancy, additional options such as contrast material-enhanced CT, positron emission tomography (PET), percutaneous needle biopsy, and thoracoscopic resection or videoassisted thoracoscopic resection should be considered.     

多层螺旋CT动态增强扫描在孤立性肺结节中的应用价值

目的对多层螺旋CT动态增强扫描在孤立性肺结节中的应用价值进行探讨。方法选取就诊于我院的单发孤立性肺结节患者60例,均给予多层螺旋CT动态扫描,对动态扫描增强后CT值改变情况、多层螺旋CT动态扫描与病理学诊断孤立性肺结节的结果进行比较。结果 1.恶性结节增强扫描后其CT值增高明显,显著高于良性结节,其差异具有统计学意义(P<0.05)。2.选择增强扫描后CT值改变≥20HU诊断为恶性结节,<20 HU诊断为良性结节,对CT增强扫描和病理学诊断在孤立性结节的诊断结果进行比较,未见明显统计学差异(χ2=1.40,P>0.05)。结论多层螺旋CT增强扫描对良恶性结节的诊断具有较高的应用价值,可以协助良恶性结节的鉴别诊断。