电视胸腔镜手术在不明原因肺孤立性小结节诊断中的价值

Value of Video-assisted Thoracoscopy for Diagnosis of Indeterminate Solitary Pulmonary Nodules

目的探讨胸腔镜手术在不明原因肺孤立性小结节中的诊断价值。方法对42例40岁以上不明原因肺孤立性小结节(直径<3cm)应用胸腔镜技术行肺小结节病灶切除,术中快速冰冻切片,对恶性病变按恶性肿瘤手术原则进一步手术,良性病变则结束手术。结果诊断恶性病变22例,其中17例原发性肺癌行胸腔镜辅助小切口肺癌根治术,2例双侧肺癌行病灶切除术,3例肺转移癌中2例肺叶切除联合局部淋巴结清扫、1例病灶切除。20例良性病变(2例机化性纤维化结节、6例肺硬化性血管瘤、5例肺炎性假瘤、7例肺错构瘤)仅行病灶切除。37例随访16～79个月,平均48个月,18例良性病变无复发;14例原发肺癌中,13例生存,1例术后38个月死亡。结论胸腔镜手术在诊断不明原因肺孤立性小结节中具有较高的应用价值,掌握良好的手术指征可明显提高恶性肿瘤的诊断率,避免长期观察和等待。

Objective To explore the value of video-assisted thoracoscopy for the diagnosis of indeterminate solitary pulmonary nodules. Methods A total of 42 patients with indeterminate solitary pulmonary nodules （ 〈 3 em in diameter） aged over 40 years were enrolled in this study. Video-assisted thoracoscopy was employed to resect the nodules for rapid frozen sections diagnosis. The cases with a malignant diagnosis were treated further; for those benign cases,surgical treatments were stopped. Results Among the cases, 22 were diagnosed with malignant tumor including 17 cases of primary lung cancer, who underwent radical resection by video-assisted thoracoscopy using small auxiliary incision ; 2 cases of bilateral lung cancer, who received resection of the lesion; and 3 cases of metastatic lung cancer that were treated by lobectomy combined with resection of local lymph nodes （ in 2 cases） or the lesion （in 1 case）. The other 20 patients were diagnosed as having benign lesions （fibrotic nodules in 2, pulmonary sclerosing hemangioma in 6, pulmonary inflammatory pseudotumor in 5, and hamartoma in 7）. Conclusions Video-assisted thoracoscopy is valuable in diagnosing indeterminate solitary pulmonary nodules. By using the method, the diagnostic rate of malignant tumor can be increased without needing a long-term observation.