摘要
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,在充分考虑浸润程度、动态变化、治疗疗效与并发症、患者身体状况及心态等因素后做出治疗决策。不同于其它类型肺癌的尽早治疗策略,GGN型肺癌治疗时间窗很宽,必须在充分考虑治疗利弊后确定治疗时机。外科手术是主要根治手段,对表现为GGN的前驱腺体病变目前普遍采取亚肺叶切除及不清扫淋巴结的术式。鉴于绝大多数GGN型肺癌属于无转移的局部病变,对不宜或不愿外科手术者可考虑采用介入根治。一般采用经皮微波、射频及氩氦刀等消融技术进行介入根治,具有创伤小、对肺组织损伤轻、可多次操作及可同步活检等优点,现有的研究结果已证实了消融治疗的可行性。超声与导航引导下经支气管消融治疗肺结节的疗效已初步得到了证实,是介入根治GGN的新途径。未来在GGN的治疗上,消融治疗有望与外科手术同等重要,根据病灶特点、部位及患者情况等来选择治疗方法,以求患者利益最大化。近几年来,消融治疗GGN的探索逐渐增多。本文将在进一步认识GGN的基础上,探索GGN的诊治策略,并从呼吸介入角度,介绍消融治疗在GGN中的应用。
The majority of incidentally found and screen-detected lung cancer is manifested as ground-glass nodule(GGN),which is more likely to be detected in the young people,women and non-smokers.An appropriate management strategy for GGN can not only reduce the mortality of lung cancer but also minimize overtreatment.Although most of persistent GGNs are finally diagnosed as adenocarcinoma or precursor glandular lesions,the GGNfeatured lung cancer is characterized as indolent growth or even non-growth.Therefore,scheduled follow-up might be safe for the special radiologic type under a certain condition.We should design the individualized diagnosis and treatment strategy for each patient.The treatment decision-making depends on various factors,including invasion,dynamic change,efficacy and safety of the treatment,as well as physical and psychic condition of the patients.Different from other types of lung cancer,the indolent feature of GGN-featured lung cancer allows a long time to intervene.Therefore,the determination of proper timing for intervention should be made cautiously.Surgical resection is still the principal treatment for GGN-featured lung cancer.However,there is still no consensus on the optimal surgical approach for GGNfeatured lung adenocarcinoma.Currently,sublobar resection without lymphadenectomy has been recommended to the patients with precursor glandular lesions.In light of the GGN-featured lung cancer which generally represents a local lesion,local ablation therapies have been used in those patients,especially in the ones who are inoperable or refuse to undergo surgery.The percutaneous local ablation includes different techniques:radiofrequency ablation,microwave ablation and argon-helium cryoablation.The local ablation is safe,minimally invasive and repeatable.In addition,it offers the advantage to biopsy and treatment synchronously.Percutaneous ablation has the potential to be an alternative of surgery to cure GGN-featured lung cancer based on emerging evidences.The efficacy of transbronchial ablation g
作者
柯明耀
陈智德
曾俊莉
雍雅智
林连城
KE Mingyao;CHEN Zhide;ZENG Junli;YONG Yazhi;LIN Liancheng(Respiratory Centre,The Second Affiliated Hospital of Xiamen Medical College,361000,Fujian,P.R.China)
出处
《中国胸心血管外科临床杂志》
CSCD
北大核心
2022年第1期11-22,共12页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
关键词
磨玻璃结节
诊治策略
经皮消融
根治
Ground-glass nodule
management strategy
percutaneous ablation
curative treatment
