肺周围型小结节的外科诊治分析(附122例报告)

摘要

目的 探讨肺周围型小结节(≤2cm)的诊断方法和外科治疗效果.方法 回顾性分析2005年1月-2010年10月收治的122例肺周围型小结节患者的临床资料,均经手术切除,病理诊断明确.结节直径1～2cm 101例,＜lcm 21例.术前所有患者常规行多层螺旋CT增强扫描(MSCTA)检查,52例行PET/CT检查,49例行经皮CT定位肺结节穿刺活检(CTNB).比较3种检查方法诊断肺癌的敏感性、特异性和诊断准确率.结果 术后病理示122例患者中良性病变29例(23.8％),恶性病变93例(76.2％).85例非小细胞肺癌中仅56例(65.9％)为Ⅰ a期早期肺癌,12例(14.1％)存在肺门、纵隔淋巴结转移.MSCTA的诊断准确率、敏感性、特异性分别为80.3％、81.7％、75.9％,与PET/CT(分别为84.6％、86.5％、80.0％)比较差异无统计学意义(P＞0.05).CTNB的诊断准确率、敏感性、特异性分别为91.8％、88.6％、100.0％,仅特异性高于MSCTA(P=0.045),余差异无统计学意义(P＞0.05).结论 MSCTA检查是鉴别肺周围型小结节良恶性的首选无创诊断方法,可疑肺癌者应积极手术治疗,倾向良性病变者可选择性进行CTNB检查.术前仔细分析CT片以明确病灶的空间位置,必要时结合CT引导下经皮肺穿刺活检是提高术中查找肺结节的速度和准确度的重要手段.%Objective To investigate the diagnostic method and surgical therapeutic outcome of small peripheral pulmonary nodules (diameter ≤2cm). Methods The data of 122 patients with small peripheral pulmonary nodules who were admitted from Jan. 2001 to Oct. 2010 and diagnosed by pathology postoperatively were retrospectively analyzed. The nodule diameter of nodules in 101 cases were 1-2 cm, and they were less than 1 cm in 21 cases. All the patients were examined by multislice spiral computed tomographic angiography (MSCTA), while 52 patients were examined by positron emission tomography/computed tomography (PET/CT), and 49 patients were subjected to CT-guided transthoracic needle biopsy (CTNB). The sensitivity, specificity and diagnostic accuracy were compared between the three methods for the diagnosis of lung cancer. Results Confirmed by postoperative pathological examination, 29 patients were suffering from benign lesions (23.8%), and 93 were with malignant lesions (76.2%). In the 85 patients with non-small cell lung cancer, only 56 (65.9%) were in early stage (Ⅰa), and in 12(14.1%) hilar and mediastinal lymph node metastases were found. The sensitivity, specificity and diagnostic accuracy was 80.3%, 81.7% and 75.9% by MSCTA, 84.6%, 86.5% and 80.1% by PET/CT, and 91.8%, 88.6% and 100% by CTNB, respectively. The specificity of CTNB was better than that of MSCTA (P=0.045), and no significant difference was found in other indexes between MSCTA, PET/CT and CTNB (P>0.05). Conclusions MSCTA can serve as the first choice for the non-invasive diagnosis of small peripheral pulmonary nodules. Surgical operation is necessary for suspected malignant lesions, and CTNB can be selectively performed in patients who are considered to have benign lesions. In order to improve the speed and accuracy in locating the pulmonary nodules during the operation, the CT imaging should be carefully reviewed before operation in order to identify the location of the lesion, and CT-guided transthoracic needle biopsy could be done when necessary.