微浸润腺癌的术前诊断和术式选择

Pretreatment diagnosis and surgical management of minimally invasive adenocarcinoma

2011年的肺腺癌病理分型以原位腺癌和微浸润腺癌替代了原有的细支气管肺泡癌,此二者因为手术预后极好而获得外科医师的关注.随着影像技术的发展,越来越多的早期肺腺癌被发现,其中CT表现以磨玻璃为主的肺腺癌可能属于微浸润腺癌.本文从微浸润腺癌的影像学特征、术中冰冻的诊断价值、术前定位的方法、磨玻璃为主型早期肺腺癌的手术方式的选择、淋巴结切除的范围、多原发肺腺癌的处理六点内容展开讨论.外科医师在微浸润腺癌的诊断和治疗中起着关键作用,但由于缺乏强有力的循证依据,目前很多方面仍存在争议.针对早期肺腺癌的诊疗规范,仍待多学科参与共同探讨.

Objective In 2011＇s new IASLC-ATS-ERS（International Association for the Study of Lung Cancer,American Thoracic Society,and European Respiratory Society） lung adenocarcinoma classification,adenocarcinoma in situ and minimally invasive adenocarcinoma（MIA） substituted for bronchioloalveolar carcinoma.The excellent prognosis wins these two histologic types a lot of attention.With the development of image technology,more and more lung adenocarcinomas are detected in early stage.Tumors showing a ground-glass nature in preoperative CT scans are more likely to be minimally invasive adenocarcinoma.This review discusses from the following 6 aspects.Imaging characteristics of MIA,the diagnostic value of intraoperative frozen section,preoperative localization,selection of surgical approaches for ground-glass opacity（GGO） nodules,the extent of lymph nodes dissection and management of multiple primary lung adenocarcinoma.The clinical guideline for early-stage lung adenocarcinoma is still controversial,strong evidence and further studies are needed.