单中心连续1817例早期肺癌诊疗经验

Experience of treatment for very early stage lung adenocarcinoma of 1 817 cases

目的探讨以微浸润型腺癌和原位腺癌为主的早期肺癌的处理方法。方法本研究回顾分析上海市肺科医院自2013年1月至2015年12月外科腺癌手术患者数据，分析其中早期肺癌所占比例以及手术处理方式，比较外科医师处理早期肺癌方式演变。结果共手术治疗8908例腺癌患者，其中原位腺癌1143例，微浸润性腺癌共674例。所有原位腺癌以及微浸润性腺癌采用胸腔镜手术。逐年分析，原位癌中肺叶切除比例逐年下降，亚肺叶切除比例增高。微浸润型腺癌的术式比例相对比较稳定。所有早期肺癌的患者均未发现淋巴结转移。结论对磨玻璃影建议随访，8mm以上的病变可以考虑手术治疗，原位腺癌尽量避免肺叶切除，不清扫淋巴结。微浸润型腺癌肺叶切除以及亚肺叶切除均适用，同时进行淋巴结采样。

Objective To discuss the treatment methods of early adenocarcinoma. Methods Analyzed all the lung ade- nocarcinoma patients who received the surgical treatment in our hospital from January 2013 to December 2015 and compare the surgical treatment for the very early stage lung adenocarcinoma. Results There are totally 8 908 lung adenocarcinomas cases enrolled. Among all the cases, there are 1 143 cases of AIS and 674 cases of MIA. VATS surgery was performed on all these very early stage of adenocarcinoma cases. The proportion of lobectomy in AIS decreased year by year, the proportion of surgery type for MIA is relatively stable. Lymph node metastasis was not found in all patients. Conclusion Both AIS and MIA are represented as ground glass opacity（GGO） in CT scan. If the lesion is larger than 8mm and has been followed up for a period can be considered for VATS. For AIS, sub-lobectomy is recommended. But for MIA, both lobectomy and sub-lobectomy are acceptable and lymph node sampling is enough.