电视胸腔镜手术切除肺部亚厘米非小细胞肺癌的临床病理特征
作者: |
1邵丰,
1杨如松,
1刘政呈,
1潘宴青,
1邹卫,
1赵一昕,
1马国栋,
1曹珲,
1王尊乔,
1孔令源
1 东南大学医学院附属南京胸科医院胸外科,南京 210029 |
通讯: |
杨如松
Email: njyrs_md@188.com |
DOI: | 10.3978/j.issn.2095-6959.2017.01.016 |
基金: | 南京市医学科技发展资金资助, 宁卫科2011-42 |
摘要
目的:总结电视胸腔镜手术切除亚厘米(≤1 cm)非小细胞肺癌患者的临床病理特征及手术方式。方法:自2009—2015年,78例肺部亚厘米结节患者,根据术前CT表现将其分为3组,纯磨玻璃样结节(ground-glass opacity,GGO)组、混合型GGO组和实性结节组。78例患者均行电视胸腔镜下微创手术,术后病理提示为非小细胞肺癌(包括原位腺癌、微浸润癌以及浸润癌),总结其临床病理特征。结果:纯GGO及混合性GGO组均未见淋巴结转移,在实性结节组可见4例患者出现淋巴结转移,其中2例为纵隔淋巴结转移,5年生存率纯GGO组为100%,混合性GGO组为99%,实性结节组为90%。结论:胸部CT表现为GGO形态(包括纯GGO和混合性GGO)的早期肺癌患者无淋巴结转移,可行包括解剖性肺段切除及楔形切除在内的亚肺叶切除术;对于实性亚厘米结节的肺部病灶,因其存在淋巴结转移可能,肺叶切除加纵隔淋巴结系统性清扫术仍然作为首选手术方式。
关键词:
电视胸腔镜
亚厘米结节
非小细胞肺癌
磨玻璃样结节
手术
临床病理特征
Clinicopathologic features of resected subcentimeter lung cancer with video-assisted thoracic surgery
CorrespondingAuthor: YANG Rusong Email: njyrs_md@188.com
DOI: 10.3978/j.issn.2095-6959.2017.01.016
Abstract
Objective: To summarize the clinicopathologic features and surgical procedure of video-assisted thoracic surgery to remove the subcentimeter nodules (≤1 cm) in patients with non-small cell lung cancer. Methods: From 2009 to 2015, 78 patients with lung subcentimeter nodules, according to appearance on high-resolution computed tomography (HRCT), were classified into three groups: pure ground-glass opacity (GGO) lesion group (n=21); mixed GGO lesion group (n=35); and solid GGO group (n=22). All patients were obtained video-assisted thoracic surgery, and postoperation pathological features showed the results of non-small cell lung cancer (including adenocarcinoma in situ, micro-invasive carcinoma and invasive carcinoma), summarizing the clinicopathological features. Results: In pure GGO group and mixed GGO group, there was no lymph node metastases, but 4 cases found in solid GGO group, in which 2 were mediastinal lymph node metastases. The 5-year overall survival rates were 100% in pure GGO group, 99% in mixed GGO group, and 90% in solid GGO group. Conclusion: Subcentimeter lung cancers with a GGO component on HRCT (pure to mixed) can be considered “early” lung cancers. In these cases, limited resection may be warranted to achieve a cure because they had no lymph node metastasis. In contrast, lobectomy and mediastinal lymph node metastases dissection should still be considered as the standard operation for solid GGO tumors.