同时性多原发肺癌的诊治体会及处理策略新进展

Experience and Progress Processing Policy of Simultaneous Multiple Primary Lung Cancer

背景与目的同时性多原发肺癌(synchronous multiple primary lung cancer,s MPLC),既往属少见疾病,但近年来由于诊疗手段的进步检出率逐渐升高。但关于MPLC的发病机制、诊断、鉴别诊断和临床处理策略仍存在诸多争议。本研究对31例s MPLC的临床资料进行总结分析,进一步探讨s MPLC的诊断、治疗和预后。方法归纳总结31例s MPLC的临床资料,回顾性分析其诊断方法、手术方式、病理资料。结果所有患者均行胸腔镜手术,无死亡病例。术前均行薄层高分辨计算机断层扫描(computed tomography,CT)发现肺部多发结节。病灶位于同侧者均同期行手术治疗,手术方式以胸腔镜下肺叶+亚肺叶切除为主;病灶位于双侧者,均分期手术,时间间隔为3个月-4个月。结论薄层高分辨CT是术前诊断s MPLC的最佳方法。s MPLC同侧肺发病率高于双侧肺(23:8),周围型多见,占94%,组织学类型以腺癌最多见,占80.6%(25/31)。胸腔镜下主病灶的肺叶切除+次要病灶的亚肺叶切除是最常用的术式。

Background and objective Simultaneity multiple primary lung cancer always is a rare disease, but in recent years due to the progress of the diagnosis and treatment means detection rate increased. This study summarized the clinical data of 31 cases of synchronous multiple primary lung cancer （sMPLC） analysis, further to explore the diagnosis, treatment and prognosis of MPLC. Methods Sum up the clinical data of 31 cases of simultaneous multiple primary lung cancer, the diagnostic method, surgical methods, pathology, were retrospectively analyzed. Results All the patients are thoracoscope surgery, no deaths. Thin high resolution computed tomography （CT） in preoperative found multiple lung nodules. Lesions located in the same side of the same period surgical treatment, the operation method is given priority to with under the thoracoscope lung ＋ the lobectomy; Lesions located in bilateral, all staged operation, the time interval for 3 months-4 months. Conclusion Thin layer distinguish CT preoperative diagnosis is the best way to simultaneous multiple primary lung cancer. Multiple primary lung cancer incidence of ipsilateral lung at the same time higher than that of bilateral lung （23：8）, type, around 94%, the most common histology to adenocarcinoma, 80.6% （25/31）. Primary lesions under thoracoscope lobectomy plus the lobectomy of secondary lesions is the most commonly used.