老年多发磨玻璃结节的外科治疗策略及疗效分析

Surgical management and outcomes of multifocal ground-glass opacities in elderly patients

目的探讨老年多发磨玻璃结节（ GGO）的外科治疗策略及疗效.方法 回顾性分析2011年1月至2013年1月于复旦大学附属华东医院胸外科收治的7 8例老年多发GGO患者,根据术 前影像学中磨玻璃结节实质部分比例,分为磨玻璃结节（GGO）组 3 4例（ C/TC0.5 ）和实质结节（SN）组 44例（ C/T〉0. 5）,比较不同手术方式对两组患者总生存率的影响,并分析影响预后的因素.结果 亚 肺叶切除组（37例） 3 年总生存率为87.3%,肺叶切除组（ 33例）为 85.6%,两组间差异无统计学意义 （χ2 = 1.285, P〉0.05）;GGO组术后3 年总生存率为97 .1%, SN组为 79 .5%, GGO总生存率显著高于 SN组（χ2 = 8.490, P〈0.05）;T1a 组 3 年总生存率为9 5 .3% ,T1b 为 7 7 .1%,T1a组总生存率显著高于 Tib 组（χ2 =8. 490, P〈0. 05）.术后预后多因素分析提示,结节直径（T）和 C/T比与预后密切相关 （P〈0.05）.结论 老年多发磨玻璃患者的亚肺叶切除具有与肺叶切除相似的治疗效果,结节直径和 C/T比是影响预后的因素.

Objective To discuss the surgical management and outcomes of multifocal ground- glass opacities （GGO） in elderly patients. Methods The clinical data of 78 elderly patients with multifocal GGO treated in Department of Thoracic Surgery, Huadong Hospital affiliated to Fudan University between January 2011 and January 2013 were retrospectively analyzed. According to the consolidation proportion on preoperative imaging findings, 34 patients were classified into GGO group （GGO-dominant lesion, C/T〉0. 5） , and 44 in SN-group （solid-dominant lesion, C/T〉0. 5） . The effects of different surgical procedures on survival of patients in two groups were compared, and the factors related to outcomes were analyzed. Results The 3-year survival in sublobar resection group （n = 37） was 87.3%, which was not significantly different from that in standard lobectomy group （n=33, 85.6%） （χ2 = 1.285 ,P〉0. 05） . The 3-year survival in GGO group was significantly higher than that in SN group （97.1% vs 79.5% y = 8.490, P〈0 . 05） . The 3-year survival in T1a group was significantly higher than that in Tib group （95. 3% vs 77.1% ,χ2 =0. 660,P 〈0.05 ） . Multivariate analysis demonstrated that nodular diameter and C/T ratio were closely related to prognosis （P 〈 0 .05 ）. Conclusions Sublobar resection for multifocal GGO is considered to be an appropriate treatment in the elderly patients as this procedure provides an equivalent long-term outcome in comparison with lobectomy. The nodular diameter and C/T ratio are associated with prognosis.