外周型孤立性肺结节的诊断和外科治疗探讨

Discussion on the diagnosis and surgical treatment of peripheral solitary pulmonary nodule

目的探讨外周型孤立性肺结节（SPN）的诊断和外科治疗。方法回顾性分析2007年1月至2012年10月诊断和治疗的外周型SPN患者69例。并以术后病理检查结果为“金标准”，判断螺旋CT增强检查的准确度，并进行一致性检验（Kappa检验）。结果术前CT诊断恶性SPN28例，术后病理证实恶性SPN25例。CT判断良恶性SPN的准确度为89．3％（25／28），Kappa值为0．503。患者均获得随访，随访时间6～12（9．6±1．4）个月。术后定期复查CT，手术患者均未发现复发，未手术患者均未发现SPN增大。结论螺旋CT增强扫描是鉴别良恶性SPN较为经济实用的方式，对CT判定为恶性的SPN应积极手术，胸腔镜辅助结合术中快速冷冻检查来判定手术的方式。

Objective To investigate the diagnosis and surgical treatment of peripheral solitary pulmonary nodule （SPN）. Methods From January 2007 to October 2012, the clinical data of 69 cases of SPN treated were analyzed prospectively. And postoperative pathologic examination results as the ＂gold standard＂ to determine spiral CT enhanced check the accuracy and consistency test （Kappa test）. Results Twenty-eight cases were diagnosed as malignant SPN by preoperative CT, 25 cases were diagnosed as malignant SPN by postoperative pathology. The accuracy of CT judgment SPN benign and malignancy was 89.3% （25/28）, the Kappa value was 0.503. All patients were followed up for 6-12 （9.6 ± 1.4） months. There was no recurrence or enlargement. Conclusions Enhanced spiral CT scan is more economical and practical way for identifying benign and malignant SPN. Malignant SPN diagnosed by CT should be considered having surgery and auxiliary thoracoscopy combined with intraoperative rapid freezing to determine the surgical approach.