38例无症状肺孤立性微小结节的电视辅助胸腔镜手术诊治

目的：探讨电视辅助胸腔镜手术（VATS）在无症状肺部孤立性微小结节的诊断、鉴别诊断以及治疗中的可行性和意义.方法：对38例无症状肺部孤立性微小结节患者进行了VATS诊治;结节直径均＜1.5cm,最小者0.3 cm;13例（34%）术前拟诊为肺癌,余25例（66%）拟诊为肺部良性病变;所有患者术前均未能获得明确病理学诊断.结果：所有患者均顺利完成手术,无严重术中、后并发症和围手术期死亡.全组患者均获得明确病理学诊断,确诊率100%.其中恶性病变11例（29%）,良性病变27例（71%）.5例（38%）术前拟诊为恶性病变的患者最终确诊为良性病变;3例（12%）术前拟诊为良性病变的患者最终确诊为恶性病变.本组中27例良性病例经VATS手术均获得临床治愈.11例肺癌患者中9例接受了根治性肺叶切除＋纵隔淋巴结清扫术;另2例患者仅接受姑息性结节楔形切除术.结论：VATS技术可应用于无症状肺孤立性微小结节的确诊,对良性或恶性病变均可获得满意的疗效,可行性良好,与传统诊疗方法相比具有明显的优势,有助于肺癌的早期诊断与治疗.

Videothoracoscopic diagnosis and treatment for 38 patients with asymptomatic small solitary pulmonary nodule

Objective: To evaluate the feasibility and significance of videothoracoscopic (VATS) operation in the diagnosis, differential diagnosis and treatment for patients with asymptomatic small solitary pulmonary nodule. Methods: Total of 38 patients with asymptomatic small solitary pulmonary nodule were treated with VATS operation. The diameter of all the nodules was less than 1.5 cm, and the smallest was 0.3 cm. Preoperatively, 13 cases (34%)were clinically diagnozed as pulmonary carcinoma and 25 cases(66%)were clinically diagnozed as benign pulmonary lesions. None the patients had got definite pathological diagnosis before operation. Results: All the patients received operations successfully. There was not severe intraoperative and postoperative complication, and there was no perioperative death. All the patients got definite pathological diagnosis, there were 11 cases (29%) of malignant lesions and 27 cases (71%) of benign lesions. 5 cases (38%) which had been clinically diagnosed as malignant lesions preoperatively were at last definitely diagnosed as benign lesions, and 3 cases (12%) which had been clinically diagnosed as benign lesions preoperatively were at last definitely diagnosed as malignant lesions. The 27 benign cases were clinically cured with VATS operation. Among the 11 cases with pulmonary carcinoma, 9 cases received radical pulmonary lobe resection plus mediastinal lymph nodes dissection, and the other 2 patients received palliative wedged resection of the nodules. Conclusion: VATS can be used in the definite diagnosis for patients with asymptomatic small solitary pulmonary methods. It can achieve satisfactory effects in patients with benign or malignant lesions. It is feasible and has significant advantage over traditional methods. It is helpful in the early diagnosis and treatment of pulmonary carcinoma.