术前不除外恶性的良性肺结节患者临床特征分析

Analysis of clinical characteristics of patients with pathology confirmed benign pulmonary nodules in which malignancy could not be excluded preoperatively

目的分析术前怀疑恶性的良性肺结节患者的临床特征,为降低临床良性肺结节切除率提供循证医学证据。方法回顾性收集2015年1月1日至2020年12月31日因肺部病变就诊于北京胸科医院胸外科且术前不能排除恶性、病理回报为良性病变的281例患者资料,其中男151例,女130例,年龄18~80(53.8±11.4)岁。分析这些患者的临床、影像学和病理学等信息。结果共纳入281例患者,占同期肺部手术总量的4.8%(281/5868),其中74.7%(210/281)因体检CT检查发现肺部病灶。患者主病灶长径4.3~99.3(20.7±15.9)mm,87.2%(245/281)病灶直径>8 mm。共切除314个病变,其中实性最多见,占67.2%(211/314),常见的特殊征象为毛刺(189/314)、分叶(122/314)、胸膜凹陷(106/314)。入组患者中,有79.7%(224/281)接受电视辅助胸腔镜手术(VATS)。手术情况,有59.1%(166/281)患者接受肺楔形切除,5.3%(15/281)例接受肺段切除,35.6%(100/281)接受肺叶切除。病理主要为炎性病变52.2%(164/281)、结核22.0%(69/281)和错构瘤14.6%(46/281)。结论怀疑恶性而切除的良性结节,影像学以实性病变为主,但多具有1个或多个恶性影像特征。对于高度怀疑恶性的病变,手术活检可作为一类备选的临床策略,但需尽量选择VATS手术和最小的切除范围。

Objective To analyze the clinical characteristics of patients with pathology confirmed benign pulmonary nodules in which malignancy could not be excluded preoperatively,to provide high-quality evidence of evidence-based medicine for reducing the resection rate of benign lung nodules.Methods This study adopts the method of retrospective analysis to collect the clinical data of 281 patients with lung lesions that malignancy could not be ruled out in preoperative assessment and pathological findings confirmed benign lung lesion.There were 151 males and 130 females aged from 18 to 80 years with an average age of(53.8±11.4)years.All of them were treated in the Department of Thoracic Surgery,Beijing Chest Hospital from January 2015 to December 2020.The clinical information,imaging and histopathologic features of patients were analyzed.Results A total of 281 patients were enrolled,accounting for 4.8%(281/5868)of the total lung operations during the same period.Among them,210 cases of lung lesions(210/281,74.7%)were detected by CT screening in physical examination.The major diameter of the main lesion was 4.3-99.3(20.7±15.9)mm,and 87.2%(245/281)of which were greater than 8 mm.A total of 314 lesions were resected.The solid nodules were the most common among the resected lesions,accounting for 67.2%(211/314).The common imaging characteristics suggesting malignancy included spicule sign(189/314),lobulation(122/314),pleural indentation(106/314).79.7%of patients(224/281)underwent video-assisted thoracoscopic surgery(VATS).59.1%of patients(166/281)accepted lung wedge resection,5.3%(15/281)lung segment resection,and 35.6%(100/281)lobectomy.Pathological findings were mainly inflammatory lesions 52.2%(164/281),tuberculosis 22.0%(69/281),and hamartoma 14.6%(46/281).Conclusions In patients with the resected benign lung nodules in which malignancy could not be excluded preoperatively,solid nodules accounted for most of these benign pulmonary lesions,but always with one or more imaging characteristics suggesting malignancy.For those highly suspected malignant lesions,a surgical biopsy can be used as the alternative clinical strategy.Still,it is necessary to choose the VATS lung resection and the smallest resection area as much as possible.