外周型孤立性肺结节的诊断与外科治疗分析

Diagnosis and surgical treatment of peripheral solitary pulmonary nodules

目的分析外周型孤立性肺结节的诊断情况,探讨外科治疗的效果。方法选取嘉兴市中医医院2016年2月至2019年2月收治的外周型孤立性肺结节患者84例为研究对象,采用随机数字表法分为对照组42例、观察组42例,对照组采用开胸手术,观察组采用电视胸腔镜手术,术中切除组织进行快速冰冻病理检查。观察两组诊断结果、手术相关指标、住院时间、临床效果、并发症发生情况。结果术中病理检查结果显示,对照组良性病变18例、恶性病变24例,观察组分别为16例、26例。良性病变均行肺结节楔形切除术,对照组恶性病变行肺叶切除术联合淋巴结清扫术,观察组行电视胸腔镜辅助下行小切口肺叶切除术联合淋巴结清扫术。观察组切口长度、术中出血量、胸管引流时间、手术时间、住院时间分别为(6.38±1.62)cm、(90.73±24.86)mL、(2.11±0.85)d、(104.84±31.35)min、(6.20±2.19)d,对照组分别为(23.15±5.26)cm、(156.82±33.74)mL、(4.03±1.24)d、(90.48±30.53)min、(10.48±3.10)d,两组差异均有统计学意义(t=19.747、10.220、8.277、2.127、7.308,均P<0.05)。观察组总有效率为95.24%(40/42),高于对照组的78.57%(33/42),差异有统计学意义(χ2=5.126,P<0.05)。观察组并发症发生率为2.38%(1/42),低于对照组的16.67%(7/42),差异有统计学意义(χ2=4.974,P<0.05)。结论开胸手术、电视胸腔镜手术在外周型孤立性肺结节的诊断中具有显著作用,但电视胸腔镜手术的治疗效果及安全性优于开胸手术。

Objective To analyze the diagnosis of peripheral solitary pulmonary nodules and explore the effect of surgical treatment.Methods From February 2016 to February 2019,84 patients with peripheral solitary pulmonary nodules admitted to Jiaxing Hospital of Traditional Chinese Medicine were selected and divided into two groups by random number table method,with 42 patients in each group.The control group was treated with thoracotomy,and the observation group was treated with video-assisted thoracoscopic surgery.Rapid frozen pathological examination was performed in tissues removed during operation.The diagnostic results,operation-related indicators,hospital stay,clinical effects and complications were observed in the two groups.Results The results of intraoperative pathological examination showed that 18 cases of benign lesions and 24 cases of malignant lesions in the control group,those were 16 cases and 26 cases in the observation group.All benign lesions underwent wedge resection of pulmonary nodules,the malignant lesions in the control group underwent lobectomy combined with lymph node dissection,while those in the observation group underwent video-assisted thoracoscopic mini-incision lobectomy combined with lymph node dissection.The incision length,intraoperative bleeding volume,thoracic drainage time,operation time and hospitalization time of the observation group were(6.38±1.62)cm,(90.73±24.86)mL,(2.11±0.85)d,(104.84±31.35)min,(6.20±2.19)d,respectively,which of the control group were(23.15±5.26)cm,(156.82±33.74)mL,(4.03±1.24)d,(90.48±30.53)min,(10.48±3.10)d,respectively,there were statistically significant differences between the two groups(t=19.747,10.220,8.277,2.127,7.308,all P<0.05).The total effective rate of the observation group was 95.24%(40/42),which was higher than 78.57%(33/42)of the control group(χ2=5.126,P<0.05).The incidence of complications in the observation group was 2.38%(1/42),which was lower than that in the control group[16.67%(7/42)],the difference was statistically significant(χ2=4.974,P<0.05).Conclusion Thoracotomy and video-assisted thoracoscopic surgery play important roles in the pathological diagnosis of peripheral solitary pulmonary nodules,but the efficacy and safety of video-assisted thoracoscopic surgery is better than thoracotomy.