摘要
目的探讨胸腔镜手术在肺微小结节（直径〈1 cm）诊治中的价值。方法回顾性分析2012年8月-2014年11月在我院行胸腔镜手术治疗的86例肺微小结节的病例资料,共100个结节。采用三孔法,术前评估结节位置,行肺楔形切除或肺段切除,术中冰冻结果回报若为良性疾病、肺泡上皮不典型增生、原位腺癌或肺转移瘤则手术结束,若为原发性肺癌则行胸腔镜肺叶切除加淋巴结清扫。结果 86例均在胸腔镜下完成手术,无中转开胸,围手术期无严重并发症,顺利出院。术后病理示恶性肿瘤53个（53.0%）。术前CT显示直径≤5 mm的11个结节中,恶性3个（27.3%）,均为原位腺癌;直径〉5mm的89个中,恶性肿瘤50个（56.2%）,其中原位腺癌21个（23.6%）。结论胸腔镜手术治疗肺微小结节安全有效,应首选肺楔形切除和肺段切除,对于〈5 mm的结节可以选择保守治疗。
Objective To explore the value of video-assisted thoracic surgery in the diagnosis and treatment of small lung nodules. Methods We retrospectively analyzed 86 patients with 100 small lung nodules who received thoracic surgery from August 2012 to November 2014 in our hospital. After assessment of nodal position before surgery, pulmonary wedge resection or lung segment resection was performed by using a 3-port thoracoseopic surgery. If the result of the intraoperative frozen pathology showed benign pulmonary diseases, atypical adenomatous hyperplasia, adenocarcinoma in situ, or pulmonary metastases, the surgery was finished. If it was the primary lung cancer, lobectomy plus lymph nodes dissection was then performed. Results The video-assisted thoracic surgery was accomplished in all the 86 patients, without conversion to thoracotomy. No serious perioperative complications occurred. All the patients were discharged from hospital. Postoperative pathology of malignant tumor accounted for 53.0%. Among the 11 nodules less than or equal to 5 mm in diameter under preoperative CT examinations, there were 3 adenocarcinomas in situ （27.3%）. Among the 89 nodules larger than 5 mm in diameter under preoperative CT scanning, there were 50 cases of malignant tumors （56.2%）, including 21 adenocareinomas in situ （23. 6% ）. Conclusions Thoracoscopic surgery is safe and effective in the treatment of small lung nodules. The preferred operation method should be the wedge resection and segmentectomy. The nodules with diameter less than 5 mm can be treated conservatively.
出处
《中国微创外科杂志》
CSCD
北大核心
2015年第9期824-826,共3页
Chinese Journal of Minimally Invasive Surgery
关键词
肺微小结节
胸腔镜
原位腺癌
Small lung nodule
Thoracoscopy
Adenocarcinoma in situ
