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。

Surgical strategies for bilateral pulmonary multiple ground-glass nodules: a retrospective analysis of single center experience

ObjectiveTo retrospectively analyze the surgical strategies for bilateral pulmonary multiple ground-glass nodules in our hospital, and to explore the best diagnosis and treatment strategy for this type of disease. MethodsA retrospective review of surgical practices for 100 patients with bilateral pulmonary multiple ground-glass nodules in single center from February 2014 to June 2017 was carried out. According to different treatment strategies, the patients were divided into four groups: unilateral surgery – contralateral follow-up (SF group) ; unilateral surgery – chemotherapy – contralateral follow-up (SCF group) ; unilateral surgery – chemotherapy – contralateral surgery (SCS group) ; unilateral surgery – synchronous contralateral surgery (SS group) . The patient’s demographics, clinical characteristics, total medical costs, and satisfaction level were recorded and compared. ResultsAll patients underwent unilateral surgery at least. There was no significant difference in chest tube duration and postoperative hospital stay (P>0.05) ; however, the pain score of synchronous bilateral surgery were higher than that of unilateral surgery (P<0.05) . No recurrence occurred and no additional nodules discovered during the follow-up periods. The total medical costs in SCS group was the largest and the SF group was the smallest. In terms of satisfaction survey, SF group was the best and SCS group was the worst. ConclusionsThe bi-pulmonary multiple ground glass nodules were mostly diagnosed as multiple primary cancers in the clinical practices. Surgery based multidisciplinary team was of great importance in dealing with these nodules. The patient’s satisfaction was a useful tool that helps us make an appropriate surgical strategy.