[1]江贤亮,徐美清*,徐世斌,等.胸腔镜肺段切除治疗亚厘米肺结节[J].中国微创外科杂志,2018,18(6):494-496.
　Jiang Xianliang,Xu Meiqing,Xu Shibin,et al.Thoracoscopic Segmentectomy for Sub-centimeter Solitary Pulmonary Nodules[J].Chinese Journal of Minimally Invasive Surgery,2018,18(6):494-496.
点击复制

胸腔镜肺段切除治疗亚厘米肺结节()
分享到：

《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
18
期数:
2018年6期
页码:
494-496
栏目:
临床研究
出版日期:
2018-09-30

文章信息/Info

Title:
Thoracoscopic Segmentectomy for Sub-centimeter Solitary Pulmonary Nodules
作者:
江贤亮; 徐美清*; 徐世斌; 柯立
安徽省立医院胸外科，合肥230001
Author(s):
Jiang Xianliang;  Xu Meiqing;  Xu Shibin;  et al.
Department of Thoracic Surgery, Anhui Provincial Hospital, Hefei 230001, China
关键词:
亚厘米; 肺结节; 电视胸腔镜手术; 肺段切除术
Keywords:
Sub-centimeter; Pulmonary nodule; Video-assisted thoracoscopic surgery; Segmentectomy
文献标志码:
A
摘要:
目的探讨胸腔镜肺段切除术治疗亚厘米孤立性肺结节（solitary pulmonary nodule，SPN）的近期疗效。方法回顾性分析2013年1月~2017年9月胸腔镜肺段切除术治疗31例亚厘米SPN的临床资料。其中纯磨玻璃样结节12例，部分实性磨玻璃样结节15例，完全实性结节4例。胸腔镜单一肺段切除21例，联合肺段切除10例。单孔7例，双孔13例，三孔11例。结果无围术期死亡。术后病理显示良性结节6例，恶性结节25例。手术时间（147.1±60.9）min，术中出血量（77.4±47.8）ml，术后住院时间（6.1±2.4）d，切缘距离（29.0±5.2）mm，淋巴结清扫数目（6.5±4.2）枚。3例持续漏气>7 d，未见其他术后并发症。术后1个月一秒用力呼气容积（FEV1）较术前仅下降（8.9±2.1）%，无疾病复发及死亡，无并发症发生。 结论亚厘米SPN采用胸腔镜肺段切除治疗，可以保证足够的切除范围及适当的淋巴结清扫，保留更多肺功能。
Abstract:
ObjectiveTo evaluate the short-term clinical outcomes of thoracoscopic segmentectomy for sub-centimeter solitary pulmonary nodules (SPN).MethodsWe retrospectively analyzed clinical data of 31 patients who underwent thoracoscopic segmentectomy from January 2013 to September 2017 in our hospital. There were 12 cases of pure ground glass opacity, 15 cases of mixed ground glass opacity and 4 cases of solid nodules. There were 21 cases of thoracoscopic uni-segmentectomy and 10 cases of thoracoscopic co-segmentectomy. Surgical ports included uniport in 7 cases, double-port in 13 cases and three-port in 11 cases.ResultsNo operative morality occurred in all the cases. Postoperative pathological examinations confirmed malignant nodules in 25 cases and benign nodules in 6 cases. The operation time was (147.1±60.9) min, the intraoperative blood loss was (77.4±47.8) ml, the postoperative hospital stay was (6.1±2.4) d, the margin distance was (29.0±5.2) mm, and the number of resected lymph nodes was 6.5±4.2. There were no other complications but 3 cases of air leakage lasting for more than 7 days. At the out-patient review at the first month after surgery, the average forced expiratory volume in one second (FEV1) was decreased by (8.9±2.1)% compared to preoperation. No recurrence, death, or late complication occurred.ConclusionThoracoscopic segmentectomy for sub-centimeter solitary pulmonary nodules has advantages of ensuring enough margin distance, appropriate resection of lymph nodes, and more residual pulmonary functions.

参考文献/References:

[1]Travis WD,Brambilla E,Burke AP,et al.WHO Classification of tumours of the lung,pleura,thymus and heart.4th edition.Lyon:International Agency for Research on Cancer,2015:9-96.
[2]Talwar A,Rahman NM,Kadir T，et al.A retrospective validation study of three models to estimate the probability of malignancy in patients with small pulmonary nodules from a tertiary oncology follow-up centre.Clin Radiol,2017,72（2）：177.e1-177.e8.
[3]严高武,严高文,孙清泉,等.CT引导下经皮肺穿刺活检对肺部毛玻璃样病变良恶性的诊断价值.中国循证医学杂志,2016,16(4):378-382.
[4]韩乐乐，张传玉，于华龙，等.CT引导经皮肺穿刺活检术对直径≤30mm肺结节诊断价值.青岛大学医学院学报，2016，52（2）：232-234.
[5]Dalli A,Selimoglu Sen H,Coskunsel M,et al.Diagnostic value of PET/CT in differentiating benign from malignant solitary pulmonary nodules.J BUON,2013,18:935-941.
[6]Stolzmann P,Veit-Haibach P,Chuck N,et al.Detection rate,location,and size of pulmonary nodules in trimodality PET/CT-MR:comparison of low-dose CT and Dixon-based MR imaging.Invest Radiol,2013,48:241-246.
[7]Mosmann MP,Borba MA,de Macedo FPN,et al.Solitary pulmonary nodule and 18F-FDG PET/CT.Part 2:accuracy,cost-effectiveness,and current recommendations.Radiol Brasil,2016,49(2):104-111.
[8]Mohiuddin K,Haneuse S,Sofer T,et al.Relationship between margin distance and local recurrence among patients undergoing wedge resection for small (<2 cm) non-small cell lung cancer.J Thorac Cardiovasc Surg,2014,147:1169-1177.
[9]El-Sherif A，Fernando HC，Santos R，et al.Margin and local recurrence after sublobar resection of non-small cell lung cancer.Ann Surg Oncol,2007,14(8):2400-2405.
[10]Wolf AS,Swanson SJ,Yip R,et al.The impact of margins on outcomes after wedge resection for stage I non-small cell lung cancer.Ann Thorac Surg,2017,104:1015-1021.
[11]Endoh H,Tanaka S,Yajima T,et al.Pulmonary function after pulmonary resection by posterior thoracotomy,anterior thoracotomy or video-assisted surgery.Eur J Cardiothorac Surg,2010,37:1209-1214.
[12]Koike T,Sato S.Lobectomy and limited resection in small-sized peripheral nonsmall cell lung cancer.J Thorac Dis,2016,8(11):3265-3274.
[13]Speicher PJ,Gu L,Brian C,et al.Sublobar resection for clinical stage IA none small-cell lung cancer in the United States.Clin Lung Cancer,2016,17:47-55.
[14]王通,闫天生,万峰,等.胸腔镜治疗肺部微小结节（129例报告）.中国肺癌杂志,2017,20(1):35-40.
[15]苏雷,支修益,张毅,等.亚厘米肺结节的外科诊疗分析.中国微创外科杂志,2017,17(1):11-14.
[16]Swensen SJ,Silverstein MD,Ilstrup DM,et al.The probability of malignancy in solitary pulmonary nodules.Application to small radiologically indeterminate nodules.Arch Intern Med,1997,157(8):849-855.

备注/Memo

备注/Memo:
*通讯作者，E-mail:xmqahslyy@163.com
更新日期/Last Update: 2018-09-30