不同密度恶性孤立性肺结节临床及病理资料分析

Analysis on clinical data of malignant solitary pulmonary nodules with different density

目的总结并分析376例确诊为肺癌的不同密度孤立性肺结节患者的临床及病理资料。方法收集2015年1月1日至2017年12月31日于南京市胸科医院就诊并经术后病理确诊为肺癌的376例孤立性肺结节患者的临床及病理资料,根据结节密度分为纯磨玻璃结节组(p GGN组) 98例,混合磨玻璃结节组(m GGN组) 153例,实质性结节组(SN组) 125例并进行分析。结果 SN组患者年龄显著高于m GGN组及p GGN组(P <0. 01)。SN组出现咳痰、体重下降症状最多(P <0. 05)。SN组结节最大径显著高于p GGN组及m GGN组,p GGN组结节最小(P <0. 01)。SN组出现分叶征、毛刺征最多,其次为m GGN组及p GGN组(P <0. 01)。SN组原位腺癌最少,分化程度以中-低分化、低分化、差分化最多,出现送检淋巴结转移及脉管、胸膜、血管壁侵犯最多(P <0. 01)。结论 CT表现不同密度的孤立性结节肺癌、临床症状、影像表现及术后病理不同,恶性实质性结节较混合磨玻璃结节及纯磨玻璃结节,恶性程度最高。

Objective To analyze the clinical and pathological data of 376 patients with varying-density solitary pulmonary nodules diagnosed as lung cancer.Methods The clinical and pathological data of 376 patients with solitary pulmonary nodules confirmed as lung cancer by postoperative pathological examination were collected from January 1,2015 to December 31,2017 in Nanjing Chest Hospital.According to their density,the solitary pulmonary nodules were divided into three groups,pure ground glass nodules(the pGGN group,98 cases),mixed ground glass nodules(the mGGN group,153 cases)and solid nodules(the SN group,125 cases).The clinical data and pathology results were analyzed among the three groups.Results The SN group were older than the mGGN group and the pGGN group(P<0.01).Expectoration and weight loss were more pronounced in the SN group than in the rest two groups(P<0.05).The maximum diameter of nodules in the SN group was significantly greater than those in the mGGN group and the pGGN group,and they were smaller in the pGGN group(P<0.01).Similarly,lobulation sign and spiculation sign occurred the most in the SN group,followed by the mGGN group and the pGGN group(P<0.01).Moreover,the proportion of adenocarcinoma in the SN group is the least.While on degree of differentiation,the nodules of meso-low differentiation,low differentiation and poor differentiationt were the most in the SN group,and the SN group had the most proportion of lymphatic metastasis and invasion to vessel,pleura and vascular wall(P<0.01).Conclusion Malignant solitary pulmonary nodules of different density have differences in symptoms,HRCT imaging,and postoperative pathology.Solid nodules have higher malignancy degree than pure ground glass nodules and mixed ground glass nodules do.