同期多发肺磨玻璃结节手术治疗结果分析

目的 总结外科手术治疗同期多发肺磨玻璃结节(SMGN)的临床经验,探讨SMGN患者个体化诊疗的策略.方法 回顾性分析2016年7月至2018年8月84例在安徽省胸科医院胸外科接受手术的SMGN患者的临床资料,其中男18例(21.4％)、女66例(78.6％),年龄32～80(55.6±10.3)岁.分析手术相关结果及磨...     

双肺多发磨玻璃结节的外科治疗策略及实践：单中心经验回顾性分析

目的回顾分析福建医科大学附属协和医院对双肺多发磨玻璃结节的外科治疗实践,探讨该类疾病的最佳诊疗策略。 方法回顾分析2014年2月至2017年6月在福建医科大学附属协和医院胸外科就诊的双肺多发磨玻璃结节的患者100例,根据不同的治疗方案,可分为四组,即单侧手术–对侧观察、随访（SF组）;单侧手术–化疗–对侧观察、随访（SCF组）;单侧手术–对侧再手术（SS组）和单侧手术–化疗–对侧再手术（SCS组）,对上述各组患者进行随访,记录总体生存情况、肿瘤复发情况和治疗的满意度调查等指标,并进行比较。 结果4组患者经历一次手术（初始治疗）,术后拔管时间、住院时间差异均无统计学意义（均P>0.05）;而同期双侧手术的疼痛评分较单侧手术的高,差异有统计学意义（P<0.05）。根据医生的建议及患者的意向,四组患者接受了不同的治疗方案（后续治疗）,四组患者在随访期间内均全部存活且未发现新增结节。在满意度调查方面,SF组最佳,SCS组最差。 结论对于双肺多发磨玻璃结节,其临床考虑多为同期多原发癌。以外科为主的多学科诊疗是核心,既可以切除病灶,也能明确病理诊断,术后根据病情辅助化疗等治疗,以提高患者的总体生存。     

肺磨玻璃结节诊治策略与消融治疗

肺磨玻璃结节(ground-glass nodule,GGN)是体检或偶发早期肺癌的主要表现形式,常见于年轻、女性和不吸烟人群,正确的随访与处理策略可在降低肺癌死亡率的同时避免过度治疗.持续存在的GGN大多数为腺癌或前驱腺体病变,但呈惰性生长或长期不生长,有条件的随访是十分安全的.GGN必须采取个体化诊治策略,在充分考...     

肺部磨玻璃结节术后急性肺动脉栓塞的防治策略

急性肺动脉栓塞(PE)是肺部磨玻璃结节(GGN)患者围术期的严重并发症,也是患者住院期间死亡的主要原因之一。临床医生应重视术前PE高危因素的评估和预测,筛查出高危患者并在术前制定完善的个体化PE预防策略。临床高度怀疑患者应尽早诊断,及时而准确地危险分层和治疗,从而提高PE的救治率,降低医疗费用、缩短住院时间。本文总结肺部GGN患者围术期发生急性PE的危险因素、诊断流程、风险评估、预防措施和治疗策略。     

薄层CT扫描在区分多发性肺癌和肺磨玻璃结节成分及预后评估中的价值

目的通过薄层CT扫描区分多发性肺癌和肺磨玻璃结节(GGO)成分,并评估其预后影响因素。 方法回顾性分析3 254例Ⅰ期肺癌行手术切除患者,其中312例(9.6%)为多发性肺癌,所有患者根据GGO大小、薄层CT上的肿瘤实性成分比值(CTR)分为磨玻璃成分为主(GD)(0 ≤CTR < 0.5)、实性成分为主(SD)(0.5 ≤CTR < 1.0)、纯实性(PS)(CTR ＝1.0)。根据影像学结果将多发性肺癌患者分为6组：GD＋GD组、GD＋SD组、GD＋PS组、SD＋SD组、SD＋PS组和PS＋PS组。采用Cox比例风险模型对比临床Ⅰ期肺癌患者的预后情况。 结果312例多发性肺癌患者中,251例(80.4%)切除了2个以上肿瘤同时病理诊断为多发性肺部肿瘤。其中GD＋ GD患者90例(28.8%),GD ＋SD患者70例(22.4%),GD＋ PS患者66例(21.2%),SD ＋SD患者16例(5.1%), SD ＋PS患者27例(8.7%),PS ＋PS患者43例(13.8%)。多变量分析显示,PS ＋PS是影响预后的独立危险因素(P<0.001)。整体生存率分别为GD＋GD组96.7%,GD ＋SD组98.6%,GD＋PS组84.8%,SD ＋SD组93.8%,SD＋ PS组77.8%,PS ＋PS组41.9%。PS ＋PS组与其他组相比差异均有统计学意义(P<0.05)。此外,剩余2 942例Ⅰ期肺癌患者的整体生存率为78.2%,与PS＋PS组相比差异也有统计学意义(P<0.001),而其他组与剩余患者相比预后类似甚至更好。 结论在多发性肺癌患者中,PS ＋PS组患者生存率更低,这可能促进T分期更新,多发肺癌患者GGO影像学形态及其类型对预后评估极其重要。     

基于高分辨CT影像学指导≤2cm磨玻璃结节肺癌手术方式胸外科专家共识(2019版)

肺癌是世界上发病率及死亡率最高的恶性肿瘤^[1],我国肺癌发病率及死亡率呈逐年上升趋势^[2]。文献^[3]报道不同分期肺癌患者生存差异明显,如ⅠA1期肺癌患者5年生存率可达92%,ⅣA期肺癌患者5年生存率仅10%,ⅣB期肺癌患者5年生存率0%。     

单孔胸腔镜在磨玻璃结节为主的早期肺癌手术切除中的应用效果研究

目的 探讨单孔胸腔镜在磨玻璃结节为主的早期肺癌手术切除中的应用效果。方法 2015年1月～2021年3月收治的磨玻璃结节为主的早期肺癌病人168例均行手术切除。按照手术方法不同分为观察组和对照组,每组各84例,观察组实施单孔胸腔镜早期肺癌根治手术,对照组则实施传统三孔胸腔镜早期肺癌根治手术。比较两组病人术后1、3、5天疼痛情况、围手术期情况、手术前后炎性反应指标变化、手术前后生活质量及术后并发症发生率。结果 观察组病人术后1天、3天、5天视觉模拟评分量表得分分别为(6.12±0.93)分、(5.12±0.73)分和(3.67±0.82)分,低于对照组的(6.53±0.91)分、(6.15±0.58)分和(4.36±0.91)分,差异有统计学意义(P<0.05)。观察组切口平均长度为(3.91±0.46)cm,引流管留置时间为(2.85±0.71)天,对照组分别为(6.63±0.86)cm和(3.69±0.87)天,两组比较差异有统计学意义(P<0.05)。观察组术后第5天C反应蛋白为(12.39±2.15)ng/L,降钙素原为(3.34±0.39)ng/ml、白细胞介素-6...     

肺纯磨玻璃结节(直径≤3 cm)的侵袭性预测

目的 探讨CT对肺纯磨玻璃结节(pGGN)浸润性的预测价值。方法 2013年6月～2016年6月在我院接受肺结节微创手术治疗的病人886例,筛选出临床资料完整的肺纯磨玻璃结节病人72例,肺纯磨玻璃结节为单发,且结节直径≤3 cm。采用logistic回归分析肺纯磨玻璃结节是否具有侵袭性的独立危险因素。采用受试者工作特征曲线(ROC曲线),以确定浸润前病变和浸润性病变的最佳截断点。结果 单因素分析表明,肺纯磨玻璃结节浸润前和浸润性病变病人的癌胚抗原、纯磨玻璃结节最大直径和最大面积存在统计学差异(P<0.05)。多因素Logistic回归分析显示,肺纯磨玻璃结节是否具有侵袭性仅有结节最大直径存在统计学差异。预测肺纯磨玻璃结节为浸润前或浸润性病变的CT最大直径的最佳截断值为1.08 cm。结论 通过测量肺纯磨玻璃结节的最大直径来预测结节的病理类型(浸润前病变和浸润性病变)是可靠的,最可靠的截断值为1.08 cm。     

磨玻璃结节型肺癌患者的个体化全程管理策略

随着胸部低剂量CT的普及,磨玻璃结节(ground-glass opacity,GGO)的检出率逐年升高.影像学表现为GGO的肺部病变病理上可能是良性病变,但持续存在的GGO多提示早期肺癌.GGO型肺癌和传统肺癌不同,常见于年轻、女性和不吸烟人群,具有惰性生长的特点,外科处理窗口期长,GGO是部分传统肺癌的早期表现.G...     

The use of the mean computed-tomography value to predict the invasiveness of ground-glass nodules: A meta-analysis

The invasiveness of ground-glass nodules (GGNs) is difficult to characterize through morphological examination. Multiple studies have independently detected a close relationship between mean computed tomography value and invasiveness of GGNs, however, their relative diagnostic accuracy is uncertain. Here, we performed a meta-analysis to validate whether the mean computed tomography value can predict the invasiveness of GGNs. Briefly, we searched the Web of Science, Embase, PubMed, Cochrane, Google Scholar, CNKI, VIP, Wanfang and SinoMed databases. The sensitivity, specificity, 95% confidence interval (CI), symmetric receiver operating characteristic curve (SROC curve) and the area under curve (AUC) were obtained using STATA 16.0 to evaluate the predictive value of the mean computed tomography value for GGNs. The presence of heterogeneity was assessed using fixed effects sensitivity analysis and I² statistics. We used the Deek's funnel plot to evaluate the possibility of publication bias. Thirteen studies encompassing 1564 GGNs were included in our meta-analysis. Six of these studies revealed that using the mean computed tomography value for the diagnosis of pre-invasive and invasive lesions had a sensitivity and specificity of 0.75 (95% CI: 0.61–0.85) and 0.81 (95% CI: 0.74–0.86), respectively. The optimal critical value was ?557 Hu. Later, eight studies were examined for the use of the mean CT value for patients with minimally invasive adenocarcinoma (MIA) and invasive adenocarcinoma (IAC); the results showed that the sensitivity was 0.78 (95% CI: 0.66–0.86) and the specificity was 0.81 (95% CI: 0.68–0.89), and the optimal critical value was ?484 Hu. Therefore, the mean computed tomography value assessed via CT scan could be a significant predictor of the invasiveness of GGNs as well as a good surgical treatment guide in patients diagnosed with lung cancer.Prospero registration numberCRD42020177125.     

肺磨玻璃样结节和亚厘米结节术前定位的研究进展

近年来,以磨玻璃样结节和亚厘米结节(≤1 cm)等微小病灶为影像学特征的早期肺癌的检出率明显增高.对于此类病灶,尽早行外科手术干预能有效延长患者的生存时间.但是在实际手术操作中,这些微小病灶难以察及,给手术带来了极大困难.目前临床上对于此类微小病灶,通常在术前CT引导穿刺定位标记的基础上实施手术切除.这种定位方法存在创伤大、并发症多等缺点,因此如何更精准定位和标记肺微小病灶是临床上亟待解决的问题.本文综述近年来肺微小病灶的定位方法和定位材料,对各种方法和材料的优缺点进行总结及分析.     

Segmentectomy for multiple adenocarcinoma presenting as ground-glass opacities after lung cancer surgery

During follow-up of patients after primary lung cancer resections, small nodules or ground-glass opacities (GGOs) are sometimes detected on chest computed tomography. We report a case with multiple GGOs that were noted after primary lung cancer resection. A 76-year-old woman, who had undergone right upper lobectomy, middle lobe partial resection, and mediastinal lymph node dissection 3 years earlier, was admitted owing to five GGOs in the right lower lobe that had been increasing in size or density. A right S6+10 segmentectomy was performed. On histology, one adenocarcinoma and four bronchioloalveolar carcinomas (BACs), as well as two additional BACs that had not been detected preoperatively, were identified. No complications occurred postoperatively. Three years 4 months later, no tumor recurrence or new lesions have been found. Given the high possibility of malignancy, the appearance of new GGOs in patients with a history of lung cancer requires appropriate investigation.     

Ground-glass opacities showing an adenoma-to-carcinoma sequence in the lung

We encountered a patient with three left lower lobe pulmonary tumors evident as discrete ground-glass opacities by computed tomography. Pathological diagnoses of the resected lesions included a focus of atypical adenomatous hyperplasia (AAH) and two localized noninvasive bronchioloalveolar carcinomas (BACs) of types A and C according to Noguchi's classification. This case supports the hypothesis of an adenoma-to-carcinoma sequence in the lung, as the coexisting lesions represented sequential adenocarcinoma progression from a precancerous lesion, AAH, to very early-stage adenocarcinoma, noninvasive BAC.     

老年人腰椎间盘突出症的手术治疗

目的探讨老年人腰椎间盘突出症的手术治疗方法及疗效。方法从1996年1月～2001年12月,对69例老年人腰椎间盘突出症患者采用不同的手术方法摘除髓核并作回顾性分析。其中施行后路扩大开窗术8例,半椎板切除术10例,以及全椎板切除术51例。结果在获得随访的52例中,平均随访时间为25个月,优良率是88%。结论老年人腰椎间盘突出症的治疗应根据其病变的特点,选择不同的手术方法才可取得优良的治疗效果。     

Objective definition and measurement method of ground-glass opacity for planning limited resection in patients with clinical stage IA adenocarcinoma of the lung

Objective: The standard operation for patients with stage IA lung adenocarcinoma is considered to be a lobectomy. Recently, some researchers have reported that patients with tumors showing greater proportions of ground-glass opacity (GGO) at computed tomography (CT) could be candidates for limited resection, because of its less aggressive nature. However, the lack of a precise definition or standard measuring method of GGO prevents its general use as an index for planning limited resection. Therefore, we attempted to define GGO based on CT number and measured it more objectively. Methods: Between 1998 and 2001, 90 patients with clinical stage IA adenocarcinoma, who underwent standard or intentional limited resection and whose images of chest high-resolution CT were preserved in Digital Imaging and Communications in Medicine (DICOM) format, constituted the study population. The tumor shadow seen on the solid window (WL, −160 HU; WW, 2 HU) was regarded as the central solid area of the tumor seen on the lung window, and GGO was defined as the whole tumor area with the exception of the central solid area. Each area was measured using Scion Image (Scion Corp., Frederick, MD). We analyzed the relationship between the proportion of GGO and both of pathologic findings and recurrence. Results: Among the 90 tumors, 31 (34.4%) were calculated to have a GGO area greater than or equal to 50%. Of these, 27 (87%) tumors were bronchioloalveolar carcinoma. Lymphatic and vascular invasions, or nodal involvement were found only in patients with a smaller proportion of GGO (<50%) (P<0.05). During the follow-up period (median 36 months), recurrences occurred in eight patients who were diagnosed as having tumors showing smaller proportion of GGO (<50%). Conclusions: Tumors with a greater proportion of GGO measured by our method are thought to have a less invasive nature. Our objective measuring method of GGO could be useful for future multicenter trials to elucidate the value of limited resection for clinical stage IA adenocarcinoma based on the proportion of GGO.     

高龄胃癌患者开腹与机器人胃癌根治术近期疗效比较分析

目的比较机器人及开腹胃癌根治术在高龄胃癌患者中的近期疗效,探究影响高龄胃癌术后并发症的独立危险因素。 方法通过回顾性分析,收集2017年5月至2021年5月期间,于解放军总医院第一医学中心普通外科医学部,161例行开腹或机器人胃癌根治术、年龄≥70岁高龄患者的临床病例资料。两组基线资料及肿瘤病理学特征的比较,差异无统计学意义(P>0.05),具有可比性。比较两组围手术期指标,以评估近期疗效。二元Logistic回归探究影响术后并发症的独立危险因素。 结果机器人组相比开腹组,手术时间显著延长[(242.92±55.12)min比(170.37±43.15)min, P<0.001]。尽管机器人组与开腹组术中估计出血量相当[100 ml (100~200) ml比100 ml (100~200)ml, P＝0.102],但机器人组术中出血量(≥400 ml)的比例较开腹组显著降低(4.8%比15.4%),差异有统计学意义(P＝0.025)。机器人组与开腹组在淋巴结清扫数目[(24.51±9.51)枚比(24.28±9.36)枚,P＝0.881)]、术后住院时间[10.0 d (9.0~12.0)d比9.1 d(8.6~11.0)d,P＝0.094]、术后总体并发症发生率(25.3%比26.9%, P＝0.815)、严重并发症发生率(8.4%比3.8%, P＝0.228)、吻合口漏发生率(2.4%比5.1%, P＝0.363)、围手术期病死率(2.4%比1.3%, P＝0.597)的差异无统计学意义。单因素及多因素分析结果显示,年龄≥80岁是影响高龄胃癌患者术后并发症发生的独立危险因素。 结论在高龄胃癌患者中,行机器人胃癌根治术的近期疗效与开腹手术相当,操作安全、可行。年龄≥80岁是高龄胃癌术后并发症发生的独立危险因素,对此类患者应注重围手术期评估及术后护理,降低并发症发生率。     

亚实性肺结节良恶性数学预测模型的建立与验证

目的 探讨亚实性肺结节良恶性病变的独立危险因素,建立恶性概率预测模型.方法 回顾性分析江苏省苏北人民医院2014～2018年人院且病理结果明确的443例亚实性肺结节患者的病例资料,包括临床资料、影像学特征及肿瘤标志物.将患者随机分为建模组和验证组,其中建模组296例,男125例、女171例,平均年龄(55.9±11.1...     

The evaluation and treatment implications of isolated pulmonary nodules in patients with a recent history of breast cancer

BACKGROUND: Breast cancer patients with pulmonary lesions are often assumed to have metastatic disease and treated palliatively. We evaluated the proportion of these patients who actually have primary lung tumor (PLT) and assessed their outcome. METHODS: We performed a 10-year retrospective review of the cancer registry in a community hospital system. RESULTS: Among 54 breast cancer patients with pulmonary nodules, biopsy was pursued in 30. Although metastatic breast cancer (MBC) was presumed in 24, biopsy showed MBC in 9 patients and PLT in 21. The two groups differed in age, stage, breast tumor size, nodal involvement, and estrogen receptor (ER) positivity. However, no variable excluded the possibility of PLT. Of those with PLT, 11 had early-stage lung disease; 9 underwent curative resection. CONCLUSIONS: Women with breast cancer and 1 or more pulmonary lesions without evidence of other metastatic disease require work-up of pulmonary lesions. Aggressive evaluation can afford treatment of lung cancer and impact survival.