胸腔镜治疗孤立性肺小结节的分析

摘要

目的：探讨小于2 cm孤立性肺结节( solitary pulmonary nodule,SPN)的临床诊断和外科治疗方法。方法对首都医科大学宣武医院2006年1月至2013年12月手术治疗的110例肺小结节进行回顾性分析。所有患者术前行胸部CT扫描,其中24例行术前病变定位。术式包括单纯病变切除或剔除术14例,肺楔形切除术62例,肺段切除术6例,肺叶切除术28例。结果术前胸部CT肺窗表现有恶性征象者43例。术后病理证实恶性结节63例(57.3%),包括原发恶性肿瘤41例,转移瘤22例。良性结节47例(42.7%)。 CT诊断肺恶性结节的敏感性为60.3%(38/63),特异性为89.4%(42/47)。结论 SPN的影像学静态特征对SPN诊断有重要意义,而动态观察在临床医生的分析判断中发挥着重要作用。对于有危险因素、直径>10 mm的SPN,应积极采取对应的检查、诊断和治疗措施。%Objective To investigate the diagnosis and surgical treatment of solitary pulmonary nodules( SPN) . Methods A total of 110 cases who experienced SPN-resection ( 48 male, 62 female ) in our hospital, from January 2006 to December 2013, were retrospectively analyzed. All cases were confirmed by chest CT scan, 24 of whom underwent preoperative lesion location. Simple excision was performed in 14 cases, wedge resection in 62 cases, segmental resection in 6 cases, and lobectomy in 28 cases. Results There were 43 cases with malignant signs in the chest CT scan before operation. Postoperative pathology confirmed malignant nodules in 63 cases (57. 3%), including 41 cases with primary lung cancer, non-small cell lung cancer(26 cases), 22 cases of metastatic tumor, 47 cases with benign nodules(42. 7%). The sensitivity of CT diagnosis of malignant SPNs was 60. 3%(38/63), the specificity was 89. 4%(42/47). Conclusion The SPN imaging features play an important role in the judgment of clinicians. The risk factors of diameter greater than 10 mm, the SPN should undergo corresponding examination, diagnosis and treatment measures.