同期手术切除肺多发磨玻璃影的临床分析

Single-stage resection of multiple pulmonary ground-glass opacities: A clinical analysis

目的总结多发肺磨玻璃影(ground-glass opacity,GGO)患者同期手术切除的技术要点。方法回顾性分析2015年11月至2019年5月65例在武汉同济医院胸外科同期行多发肺GGO切除患者的临床资料,其中男13例、女52例,平均年龄(56.0±9.4)岁,分析患者手术情况及肺GGO相关信息。结果患者发现GGO至手术时间间隔8~1447(236.5±362.4)d。同期单侧手术48例,同期双侧手术17例,除2例患者因全胸腔粘连中转开胸外,其余均为胸腔镜手术,无围手术期严重并发症及死亡病例,术后平均住院时间(12.2±4.3)d。共切除GGO病灶156个,纯GGO 80个,其中恶性58个(72.5%),平均直径(7.7±3.3)mm,良性22个(27.5%),平均直径(5.5±2.6)mm;混合GGO 76个,其中恶性69个(90.8%),平均直径(13.6±6.6)mm,良性7个(9.2%),平均直径(7.7±3.5)mm。结论患者发现肺多发GGO时应进行规范抗炎治疗,当保守治疗无效且经观察后无良性转归者应考虑外科手术治疗。此类患者病灶为恶性可能性大,在肺功能允许时可考虑同期单侧或双侧胸腔镜多病灶切除,根据病灶临床特征及术中快速病理结果可灵活采取亚肺叶及(或)肺叶切除方法,不会增加患者术后并发症风险;如评估患者无法耐受同期多病灶切除,直径>7.7 mm的GGO病灶应优先考虑手术切除。

Objective To summarize our experience of surgical resection of multiple ground-glass opacity(GGO)in recent years.Methods Clinical data of patients who underwent one-stage resections of multiple GGO from November 2015 to May 2019 in our hospital were collected,including 13 males and 52 females at an average age of 56.0±9.4 years.The clinical effects and pathological types of GGO were evaluated.Results Time interval from first discovery to surgery was 8-1447(236.5±362.4)days.There were 48 patients with unilateral surgery and 17 patients with bilateral surgery during the same period.Except for 2 patients who underwent open thoracotomy due to total thoracic adhesions,other patients underwent video-assisted thoracoscopic surgery(VATS).The mean postoperative hospital stay was 12.2±4.3 days.No severe perioperative complication or death occurred.A total of 156 GGO lesions were resected,80 lesions were pure GGO,including 58(72.5%)malignant lesions and 22(27.5%)benign lesions,with an average diameter of 7.7±3.3 mm and 5.5±2.6 mm,respectively.Another 76 lesions were mixed GGO,including 69(90.8%)malignant lesions and 7(9.2%)benign lesions,with an average diameter of 13.6±6.6 mm and 7.7±3.5 mm,respectively.Conclusion Patients with multiple GGO should be treated with anti-inflammatory therapy firstly.When conservative treatment is ineffective and no benign outcomes are observed,surgical treatment should be considered.And when lung function is sufficient for patients to underwent surgeries,the simultaneous unilateral or bilateral thoracoscopic resection is suggested,and the sublobar resection or lobectomy methods can be adopted flexibly according to the clinical features of the lesion and the rapid pathological results,which will not increase the risk of postoperative complications.Otherwise,surgical resection should be given priority for pure GGO lesions with a diameter>7.7 mm and mixed GGO lesions.