摘要
目的分析影响孤立性肺结节(SPN)良恶性的相关因素,并观察胸腔镜切除SPN的手术情况,为临床诊疗SPN提供参考。方法回顾性分析辽宁省肿瘤医院自2018年6月至2019年12月收治的接受胸腔镜切除手术的126例SPN患者的临床资料。根据病理检查结果,将患者分入恶性组和良性组;比较恶性组和良性组患者的一般资料;采用Logistic回归分析SPN良恶性的影响因素;记录接受不同术式胸腔镜切除手术患者的围术期指标。结果126例SPN患者中:恶性104例(82.54%,恶性组),包括鳞癌51例,腺癌46例,小细胞癌1例,大细胞癌4例,腺鳞癌2例;良性22例(17.46%,良性组),包括炎性肉芽肿12例,结核瘤9例,错构瘤1例。良性组和恶性组患者在年龄、结节直径、癌胚抗原水平及钙化、分叶征、毛刺征、血管集束征、空泡征、胸膜凹陷征比例方面的差异均有统计学意义(P<0.05)。年龄、结节直径、分叶征、毛刺征、血管集束征、空泡征、胸膜凹陷征均是影响SPN良恶性的独立因素(P<0.05)。126例SPN患者中,行楔形切除术37例(29.37%),行肺段切除术11例(8.73%),行肺叶切除术78例(61.90%),均未出现严重并发症及围术期死亡;行肺段切除术和肺叶切除术患者的手术时间、住院时间、引流管留置时间均长于行楔形切除术的患者,术中失血量也多于行楔形切除术的患者,差异有统计学意义(P<0.05)。结论年龄、结节直径、分叶征、毛刺征、血管集束征、空泡征、胸膜凹陷征均是影响SPN良恶性的独立因素。胸腔镜手术可兼顾SPN的诊断和治疗,与肺段切除术和肺叶切除术比较,楔形切除术的手术创伤更小,患者恢复更快。
Objective To analyze the related factors affecting the benign and malignant characteristics of solitary pulmonary nodules(SPN),and observe the operative situation of thoracoscopic surgery of SPN,so as to provide reference for the clinical diagnosis and treatment of SPN.Methods A retrospective study was performed on 126 cases of SPN patients who were admitted and underwent thoracoscopic surgery from June 2018 to December 2019.All patients received pathological examination,and according to the examination results,patients were divided into the malignant group and benign group;general data of malignant and benign patients were compared;Logistic regression was used to analyze the benign and malignant factors of SPN.The perioperative parameters of patients undergoing different thoracoscopic resection were recorded.Results Among the 126 SPN patients,104 cases(82.54%,malignant group)were malignant,including 51 cases of squamous cell carcinoma,46 cases of adenocarcinoma,1 case of small cell carcinoma,4 cases of large cell carcinoma and 2 cases of adenosquamous carcinoma;22 cases(17.46%,benign group)were benign,including 12 cases of inflammatory granuloma,9 cases of tuberculoma and 1 case of hamartoma.There were significant differences in age,diameter of nodule,CEA level and the proportion of calcification,lobulation sign,burr sign,vascular cluster sign,vacuole sign and pleural depression between benign group and malignant group(P<0.05).Age,diameter of nodule,lobulation sign,burr sign,vascular cluster sign,vacuole sign and pleural depression sign were all independent factors affecting the benign and malignant of SPN(P<0.05).Among the 126 SPN patients,37 cases(29.37%)underwent wedge resection,11 cases(8.73%)underwent pulmonary segemectomy and 78 cases(61.90%)underwent lobectomy.No serious complications or perioperative death occurred.The operative time,hospital stay and indwelling time of drainage tube in patients undergoing segemectomy and lobectomy were longer than those undergoing wedge resection,and the intraoperative blood loss was also longer than those undergoing wedge resection,with statistical significance(P<0.05).Conclusion Age,diameter of nodule,lobulation sign,burr sign,vascular cluster sign,vacuole sign and pleural depression sign are all independent factors affecting the benign and malignant of SPN.Thoracoscopic surgery provides both diagnosis and treatment of SPN.Comparing with segmentectomy and lobectomy,wedge resection is less invasive and patients recover more quickly.
作者
吕健
鲍沈平
李鹏飞
LYU Jian;BAO Shen-ping;LI Peng-fei(PLA 95913 Unit Health Center,Shenyang 110000,China;Department of the First Outpatient,General Hospital of Northern Theater Command,Shenyang 110001,China;Department of Thoracic Surgery,Liaoning Cancer Hospital,Shenyang 110046,China)
出处
《临床军医杂志》
CAS
2021年第2期139-142,共4页
Clinical Journal of Medical Officers
基金
辽宁省自然科学基金(2019-ZD-0587)。
关键词
孤立性肺结节
胸腔镜手术
肺楔形切除
Solitary pulmonary nodule
Thoracoscopic surgery
Pulmonary wedge resection
