以肺亚段为解剖单元的肺结节手术策略及临床结果的单中心回顾性分析

A single-center retrospective analysis of surgical strategy and clinical outcome of pulmonary nodules using pulmonary subsegments as anatomical unit

目的针对肺内直径≤2 cm需手术干预的肺结节,分析"以病灶为中心,肺亚段为解剖单元"的手术策略的治疗结果及合理性。方法回顾性分析2017年1月至2018年10月于南京医科大学第一附属医院胸外科接受手术治疗的246例肺结节患者的临床资料,其中男76例、女170例,平均年龄(53.30±11.82)岁。按手术方式不同将患者分成四组,单肺段切除组、肺段联合邻近亚段切除组、单亚段切除组和联合亚段切除组,比较术前、术中及术后相关资料。结果无围术期死亡。四组在性别(P=0.163)、年龄(P=0.691)、结节直径(P=0.743)、结节纵向位置(深度比,P=0.831)、术后有无漏气(P=0.752)、术中出血量(P=0.135)、病理类型(P=0.951)、TNM分期(P=0.995)等方面差异无统计学意义;在结节横向位置(P<0.001)、涉及亚段数目(P<0.001)方面差异有统计学意义。多元logistic回归分析结果显示,肺段联合邻近亚段切除与联合亚段切除相比,采取肺段联合邻近亚段手术方式的肺结节为段间结节的比值比(OR)为5.759[95%CI(1.162,28.539),P=0.032]。结论针对直径≤2cm的需手术处理肺结节,规划以"病灶为中心,肺亚段为解剖单元"的手术策略安全可行。对于中带和外带的直径≤2 cm肺结节,结节的横向位置是影响手术方式选择的重要因素,结节深度不是影响因素;对于内带肺结节,直径是影响手术方式选择的原因之一。

Objective To analyze the results and rationality of the lesion-focused strategy with subsegment as the pulmonary anatomical unit for pulmonary nodules with a diameter of≤2 cm which require surgery.Methods Clinical data of 246 patients with pulmonary nodules who underwent surgery in the Department of Thoracic Surgery of The First Affiliated Hospital of Nanjing Medical University from January 2017 to October 2018 were retrospectively analyzed,including 76 males and 170 females,with an average age of 53.30±11.82 years.The patients were divided into four groups,a single segmentectomy group,a segmentectomy combined with adjacent subsegmentectomy group,a single subsegmentectomy group and a combined subsegmentectomy group,according to the different surgical approaches,to compare preoperative,intraoperative,and postoperative related data.Results There was no perioperative death.Among the four groups,there was no statistical difference in gender(P=0.163),age(P=0.691),diameter of the nodule(P=0.743),longitudinal position of the nodule(depth ratio,P=0.831),postoperative pulmonary leakage(P=0.752),intraoperative blood loss(P=0.135),pathological type(P=0.951)or TNM stage(P=0.995);there were statistical differences in transverse position of the nodule(P<0.001)and number of subsegments involved(P<0.001).The results of multivariate logistic regression analysis showed that compared with combined subsegmentectomy,the odds ratio(OR)of the lung nodule in segmentectomy combined with adjacent subsegmentectomy as intersegment nodules was 5.759(95%CI 1.162 to 28.539,P=0.032).Conclusion The surgical strategy of lesion focused and subsegment as anatomical unit is safe and feasible for surgical treatment of pulmonary nodules with diameter≤2 cm.The transverse position of the nodules is an important factor affecting the choice of surgical method for the middle and lateral nodules with a diameter of≤2 cm,and the longitudinal location of the nodule is not an influencing factor.For nodules in inner zone,the diameter also is one of the factors influencing the choice of surgical method.