胸腔镜肺段切除术诊治磨玻璃结节的效果

doi:10.3877/cma.j.issn.1674-0785.2022.01.003

目的

分析三维重建指导胸腔镜肺段切除术诊治磨玻璃结节（GGN）的效果。

方法

回顾性分析2020年10月至2021年6月于北京大学国际医院接受三维重建指导胸腔镜肺段切除术9例GGN患者临床资料。

结果

9例患者均顺利完成三维重建指导胸腔镜肺段切除术，其中，右肺上叶2例，右肺下叶1例，左肺上叶5例，左肺下叶1例，无中转开胸，R0切除率为100%。手术时间（377.89±115.96）min，术中出血为（150.00±96.82）ml。术后最高视觉模拟评分法（VAS）评分为（3.67±0.71）分，术后引流时间（6.33±2.39）d，术后引流总量（1 278.89±511.23）ml，术后住院时间（8.78±2.68）d。术后引流时间＞7 d者1例（11.11%），拔管延迟原因为肺漏气。9例患者均出现术后并发症，其中，1级4例，2级5例，无3~5级严重并发症或围术期死亡。清扫淋巴结3~6组［（4.89±1.05）组］，清扫淋巴结11~20个［（14.00±2.73）个］。

结论

三维重建指导胸腔镜肺段切除术诊治GGN安全有效。

关键词: 三维重建, 胸腔镜手术, 肺段切除术, 磨玻璃结节

Objective

To analyze the role of three-dimensional reconstruction guided thoracoscopic segmentectomy in the diagnosis and treatment of ground glass nodules (GGN).

Methods

The clinical data of nine patients with GGN who underwent three-dimensional reconstruction guided thoracoscopic segmentectomy at the Peking University International Hospital from October 2020 to June 2021 were retrospectively analyzed.

Results

All the nine patients successfully underwent three-dimensional reconstruction guided thoracoscopic segmentectomy. The nodules were located in the right superior lobe in two patients, in the right inferior lobe in one patient, in the left superior lobe in five patients, and in the left inferior lobe in one patient. There was no conversion to thoracotomy, and the rate of R0 resection was 100% (9/9). The operation time was (377.89±115.96) min, and the intra-operative bleeding loss was (150.00±96.82) ml. The duration of postoperative drainage was (6.33±2.39) d, the total amount of postoperative thoracic drainage was (1 278.89±511.23) ml, and the duration of postoperative hospitalization was (8.78±2.68) d. There was one (11.11%) patient whose postoperative thoracic drainage time was >7 d, and the main cause of delayed extubation was prolonged lung air leakage. All the nine patients had postoperative complications, including four with grade 1 complications and five with grade 2 complications; no grades 3-5 complications or perioperative death occurred. The number of groups of dissected lymph nodes was 3-6 [(4.89±1.05)], and the total number of dissected lymph nodes was 11-20 [(14.00±2.73)].

Conclusion

Three-dimensional reconstruction guided thoracoscopic segmentectomy is safe and effective in the diagnosis and treatment of GGN.

Key words: Three-dimensional reconstruction, Thoracoscopic surgery, Segmentectomy, Ground glass nodules

1	Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries [J]. CA Cancer J Clin, 2018, 68(6): 394-424.
2	Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015 [J]. CA Cancer J Clin, 2016, 66(2): 115-132.
3	Hirsch FR, Scagliotti GV, Mulshine JL, et al. Lung cancer: current therapies and new targeted treatments [J]. Lancet, 2017, 389(10066): 299-311.
4	Oudkerk M, Liu S, Heuvelmans MA, et al. Lung cancer LDCT screening and mortality reduction-evidence, pitfalls and future perspectives [J]. Nat Rev Clin Oncol, 2021, 18(3): 135-151.
5	姜格宁, 陈昶, 朱余明, 等. 上海市肺科医院磨玻璃结节早期肺腺癌的诊疗共识(第一版) [J]. 中国肺癌杂志, 2018, 21(3): 147-159.
6	Zhang Y, Fu F, Chen H. Management of ground-glass opacities in the lung cancer spectrum [J]. Ann Thorac Surg, 2020, 110(6): 1796-1804.
7	尚立群, 张少露, 屈志刚, 等. 新型冠状病毒肺炎疫情期间单孔胸腔镜在胸部急诊手术中的优势及围手术期处理 [J/OL]. 中华临床医师杂志(电子版), 2020, 14(6): 452-455.
8	朱征, 张明, 王勇, 等. 单孔全胸腔镜解剖性肺段切除术治疗早期非小细胞肺癌 [J]. 中国微创外科杂志, 2019, 19(10): 887-889,893.
9	陈义初, 皮名安. 单操作孔与全胸腔镜在小儿纵膈肿瘤手术中的应用比较 [J/OL]. 中华临床医师杂志(电子版), 2018, 12(9): 488-491.
10	Ettinger DS, Wood DE, Aisner DL, et al. Non-small cell lung cancer, Version 5.2017, NCCN Clinical Practice Guidelines in Oncology [J]. J Natl Compr Canc Netw, 2017, 15(4): 504-535.
11	Postmus PE, Kerr KM, Oudkerk M, et al. Early and locally advanced non-small-cell lung cancer (NSCLC): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up [J]. Ann Oncol, 2017, 28(suppl_4): iv1-iv21.
12	刘瀚, 陈亮, 朱全, 等. 完全胸腔镜下解剖性肺段切除术与肺叶切除术治疗肺部小结节的近期疗效比较 [J/OL]. 中华临床医师杂志(电子版), 2012, 6(13): 103-105.
13	赖志伟, 张珂. 3D 技术在肺段切除术中的临床应用 [J]. 中国胸心血管外科临床杂志, 2021, 28(5): 603-608.
14	Wang B, Guo Y, Tang J, et al. Three-dimensional custom-made carbon-fiber prosthesis for sternal reconstruction after sarcoma resection [J]. Thorac Cancer, 2019, 10(6): 1500-1502.
15	Li F, Sone S, Abe H, et al. Malignant versus benign nodules at CT screening for lung cancer: comparison of thin-section CT findings [J]. Radiology, 2004, 233(3): 793-798.
16	钟斌, 吴奇勇, 童继春, 等. 胸腔镜肺段或肺叶切除术治疗肺磨玻璃结节的比较研究 [J]. 中国微创外科杂志, 2017, 17(1): 62-62, 68.
17	Mironova V, Blasberg JD. Evaluation of ground glass nodules [J]. Curr Opin Pulm Med, 2018, 24(4): 350-354.
18	Dai C, Shen J, Ren Y, et al. Choice of surgical procedure for patients with non-small-cell lung cancer ≤1 cm or >1 to 2 cm among lobectomy, segmentectomy, and wedge resection: a population-based study [J]. J Clin Oncol, 2016, 34(26): 3175-3182.
19	滕啸, 刘成武, 廖虎, 等. 直径小于 2 cm 实性非小细胞肺癌的淋巴结转移及危险因素分析 [J]. 中国胸心血管外科临床杂志, 2017, 24(4): 254-258.
20	Zhong C, Fang W, Mao T, et al. Comparison of thoracoscopic segmentectomy and thoraco- scopic lobectomy for small-sized stage IA lung cancer [J]. Ann Thorac Surg, 2012, 94(2): 362-367.
21	Sagawa M, Oizumi H, Suzuki H, et al. A prospective 5-year follow-up study after limited resection for lung cancer with ground-glass opacity [J]. Eur J Cardiothorac Surg, 2018, 53(4): 849-856.
22	张家豪, 张亚杰, 李鹤成. 早期肺癌肺段切除:从技术到临床研究 [J]. 中国胸心血管外科临床杂志, 2020, 27(10): 1127-1123.
23	Ettinger DS, Wood DE, Akerley W, et al. Non-small cell lung cancer, version 1.2015 [J]. J Natl Compr Canc Netw, 2014, 12(12): 1738-1761.
24	陈晓峰, 王安. 胸腔镜解剖性肺段切除术治疗早期非小细胞肺癌的应用进展 [J]. 中国胸心血管外科临床杂志, 2018, 25(11): 1000-1002.
25	查鹏, 陈艳艳, 张蔚萱, 等. 左右侧胸腔镜肺上叶切除术后胸腔引流情况的对照研究 [J]. 中国微创外科杂志, 2021, 21(3): 253-256..
26	Nakamura K, Saji H, Nakajima R, et al. A phase Ⅲ randomized trial of lobectomy versus limited resection for small-sized peripheral non-small cell lung cancer (JCOG0802/WJOG4607L) [J]. Jpn J Clin Oncol, 2020, 40(3): 271-274.
27	高树庚, 邱斌, 郭晓彤, 等. 胸腔镜解剖性部分肺叶切除手术技巧 [J/OL]. 中华胸部外科电子杂志, 2016, 3(2): 122-124.
28	Wang H, Hu Wb, Ma L, et al. Digital chest drainage system versus traditional chest drainage system after pulmonary resection: a systematic review and meta-analysis [J]. J Cardiothorac Surg, 2019, 14(1): 13.

[1]	唐浩, 梁平, 徐小江, 曾凯, 文拨辉. 三维重建指导下腹腔镜右半肝加尾状叶切除治疗Bismuth Ⅲa型肝门部胆管癌的临床研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 688-692.
[2]	罗勇, 麦刚. 三维重建技术在腹腔镜肝尾状叶切除术中的效果[J]. 中华普外科手术学杂志(电子版), 2022, 16(06): 639-642.
[3]	李三祥, 李佳, 刘俊峰, 吕东晨, 方晖东, 谭朝晖, 刘杰, 潘佐, 乔建坤. 基于CT影像的三维重建成像技术在腹腔镜大肾上腺肿瘤切除术中的应用[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(06): 570-574.
[4]	周子健, 吴忠. CT在泌尿系结石诊疗中的应用进展[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(03): 299-302.
[5]	葛卫卫, 李伟, 李荣兴, 成亚会, 李青松. MSCT与HRCT在不同病理类型肺磨玻璃结节中的临床应用[J]. 中华肺部疾病杂志(电子版), 2023, 16(04): 572-574.
[6]	邢海东, 胡满意, 许贺松, 李强. CT纹理特征对肺磨玻璃结节生长倾向的预测意义[J]. 中华肺部疾病杂志(电子版), 2023, 16(03): 406-408.
[7]	赵璐, 尹文静, 贾萌. 不同肺复张策略在老年胸腔镜术中的临床应用[J]. 中华肺部疾病杂志(电子版), 2023, 16(03): 382-384.
[8]	郝昭昭, 李多, 南岩东. 以肺磨玻璃结节为表现的肺腺癌发生机制研究进展[J]. 中华肺部疾病杂志(电子版), 2023, 16(03): 435-437.
[9]	熊廷伟, 褚志刚, 吕发金. 肺磨玻璃结节自然衍变规律与CT鉴别诊断研究现状及进展[J]. 中华肺部疾病杂志(电子版), 2023, 16(02): 290-292.
[10]	白奇之, 杨柳青, 葛晓东, 张磊, 郑景新. 人工智能对肺磨玻璃结节参数及病理分析[J]. 中华肺部疾病杂志(电子版), 2022, 15(05): 730-732.
[11]	马木提江·木尔提扎, 汪永新, 阿西木江·阿西尔, 姜彦文, 秦虎. 多模态三维影像融合技术在颅内功能区病变手术中的应用[J]. 中华神经创伤外科电子杂志, 2023, 09(05): 302-307.
[12]	王奎重, 王天助, 袁冶, 胡金娜, 杜嘉庚, 袁绍纪. 三维重建术前计划在经侧脑室后角穿刺脑室-腹腔分流术中的应用[J]. 中华神经创伤外科电子杂志, 2022, 08(06): 361-364.
[13]	王新桥, 马超英, 张旭光. 纵隔单中心型Castleman病诊治体会及文献复习[J]. 中华胸部外科电子杂志, 2023, 10(03): 183-187.
[14]	贾卓奇, 李硕, 陈健, 张广健, 付军科. 新辅助治疗后胸腹腔镜下Ivor-Lewis食管胃结合部腺癌根治术1例并文献复习[J]. 中华胸部外科电子杂志, 2023, 10(02): 111-116.
[15]	郑成文, 洪涛, 孙滕, 张昊. 机器人和胸腔镜胸腺切除术学习曲线比较[J]. 中华胸部外科电子杂志, 2023, 10(01): 15-21.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

Thoracoscopic segmentectomy for diagnosis and treatment of ground glass nodules

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

Thoracoscopic segmentectomy for diagnosis and treatment of ground glass nodules