浅析磨玻璃密度肺结节的诊疗思路

A brief analysis of the diagnosis and treatment of ground glass density pulmonary nodules

随着人们健康意识的提高、体检频率的增加及低剂量胸部螺旋CT的广泛应用,肺内结节的检出率呈持续性上升趋势,以磨玻璃结节为表现的肺腺癌检出率也明显提高。在非手术治疗的空窗期合理应用中医药对磨玻璃密度肺结节进行干预是尤为必要的。虚、毒、痰、瘀是磨玻璃密度肺结节的主要病理因素,正气亏虚是肺内结节发生的根本并且贯穿于疾病的始终。治则应标本兼顾,在化痰祛瘀、解毒散结的同时还应兼顾肺脏的固护。依据中医整体观念理论与藏象理论,肺、脾、肾三脏同调才能固护肺金,同时肝气的疏泄也不容小觑,脏腑同治则气机得疏、水道得通、血行无阻,无物质与能量代谢失常障碍,绝结节生成之源。应将中医理论及中医药应用与现代科学技术检查手段相结合,即积极干预和密切观察双管齐下,以防止磨玻璃密度肺结节向恶病质进展,为磨玻璃密度肺结节的中西医结合诊疗提供新思路。

With the improvement of people’s health awareness,the increase in the frequency of physical examinations and the wide application of low-dose chest spiral CT,the detection rate of nodules in the lungs has shown a continuous upward trend,and the detection rate of lung adenocarcinomas with ground glass nodules has also increased significantly.It is particularly necessary to use TCM to intervene in pulmonary ground glass nodules during the window period of non-surgical treatment.The core pathogenesis of the lung ground glass nodule is deficiency,toxic,sputum,stasis.Deficiency of healthy Qi(气)is fundamental to the occurrence of nodules in the lungs and runs through the entire disease.Treatment should take into account both the symptoms and the root causes,and the solid protection of the lungs should also be taken into account while eliminating phlegm and dispelling stasis,detoxifying and loosening the knots.According to the overall concept theory of TCM and the theory of visceral manifestation,the homogeneity of the three organs of the lungs,spleen and kidneys can solidify the lung gold,and the drainage of liver Qi should not be underestimated,and the organs and intestines should be treated by the same treatment to dredge Qi movement,waterways and blood flow,there is no material and energy metabolism disorder,without the generation of nodules.Combining the theory of TCM and the application of TCM medicine with modern scientific and technological examination methods,that is,active intervention and close observation are two-pronged to prevent the progress of lung ground glass nodules to cachexia,should be performed to provide new ideas for the integrated diagnosis and treatment of lung ground glass nodules.