不同成分肺结节的临床特征、病理类型分析

Clinical features and pathological types of pulmonary nodules with different components

目的评价不同成分肺结节的临床特征、病理类型及预后。方法回顾性分析2015年至2017年经本院就诊并经CT诊断为肺结节的111例患者相关资料。所有结节均行电视辅助胸腔镜手术(VATS)切除,并获得明确的病理结果。通过分析不同成分肺结节的临床特征及病理类型,评价其临床预后。结果手术切除及获得病理的结节共计117个,其中纯磨玻璃结节37个,混合型磨玻璃结节64个以及实性结节16个,不同成分的结节均多见于女性,尤其是纯磨玻璃结节(pGGN)(83.8%,P=0.027),实性结节的直径显著大于混合型磨玻璃结节(mGGN)和pGGN(P<0.001),不同成分的结节均多位于右肺上叶。所有结节手术并发症的发生率为9.0%(10/111)。不同成分的结节其病理类型差异有统计学意义(P<0.05),pGGN病理类型以原位腺癌(AIS)为主(51.4%,P<0.001),mGGN也以AIS为主(37.5%,P=0.001),而实性结节的病理类型主要为浸润性腺癌(IAC)及其他(P<0.001)。恶性肿瘤组结节成分以mGGN为主,良性病变组以pGGN为主,且差异有统计学意义(P=0.033)。恶性肿瘤组与良性病变组结节均好发于右肺上叶,但差异无统计学意义(P=0.796),且恶性肿瘤组与良性病变组在结节大小及术后并发症方面差异均无统计学意义(P>0.05)。结论肺结节的成分与病理类型关系密切,随着结节内实性成分的增多、结节直径的增大,有可能发展为浸润性腺癌。肺结节的CT筛查有利于早期肺癌的诊断与治疗,从而改善临床预后。

Objective To investigate the clinical features,pathology and prognosis of pulmonary nodules.Methods The data of patients with pulmonary nodules diagnosed by computed tomography(CT)in the Affiliated Hospital of Yangzhou University from 2015 to 2017 were analyzed retrospectively.The pathological results of all the nodules that were resected by video-assisted thoracoscopic surgery(VATS)were obtained definitely.Moreover,the prognosis of pulmonary nodules was also investigated by analyzing their clinical features and pathology.Results Of all 117 pulmonary nodules,the number of pure ground glass nodules(pGGN),mixed ground glass nodules(mGGN)and solid nodules was 37,64,and 16,respectively.Nodules of different compositions are more common in women,and are mostly located in the upper lobe of the right lung.There were significant differences in the pathological types of nodules with different components.The pathological results of pGGNs were mainly adenocarcinoma in situ(AIS)(51.4%,P<0.001),and mGGNs were also characterized by AIS(37.5%,P=0.001),while solid nodules were mainly invasive adenocarcinoma(IAC)and others(P<0.001).Meanwhile,the diameter of solid nodules was significantly larger than that of mixed ground glass nodules and pure ground glass nodules[(17±8)mm,P<0.001],and the diameter of IAC in the mGGNs[(15±7)mm,P<0.001]and solid nodules[(22±8)mm,P=0.031]was significantly larger than other pathological types.In addition,the prevalence of complications after thoracoscopic surgery was 9.0%(10/111),and symptomatic treatment was effective after 1-3 months.Conclusions The components and diameter of pulmonary nodules were closely related to lung adenocarcinoma.With the increase of solid components and diameter of nodules,it is possible to develop into IAC.Therefore,CT screening of pulmonary nodules is beneficial to the diagnosis and treatment for early lung cancer,and significant to the improvement of prognosis.