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ENGLISH ABSTRACT
肺部恶性磨玻璃结节的外科诊治现状
程良
江中辉
高薇
赵永生
付茂勇
作者及单位信息
·
DOI： 10.3760/cma.j.issn.1001-4497.2019.12.014
Current status of surgical diagnosis and treatment of pulmonary malignant ground glass nodules
Cheng Liang
Jiang Zhonghui
Gao Wei
Zhao Yongsheng
Fu Maoyong
Authors Info & Affiliations
Cheng Liang
Department of Thoracic, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
Jiang Zhonghui
Department of Thoracic, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
Gao Wei
Department of Thoracic, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
Zhao Yongsheng
Department of Thoracic, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
Fu Maoyong
Department of Thoracic, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
·
DOI： 10.3760/cma.j.issn.1001-4497.2019.12.014
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摘要

近年来，随着影像学技术的发展，越来越多的肺部磨玻璃结节(ground－glass nodule，GGN)被发现。GGN被检出后，需结合现有检查手段，进一步判断其良恶性。常见的判断检查手段包括PET/CT、纤支镜、CT引导穿刺活检以及高清薄层CT(HRCT)，各有优劣。而对恶性风险大的GGN，需行微创外科手术干预，阻止疾病的进展。外科治疗中，微创手术方式的选择、GGN的肺内精准定位、术中冰冻病检的准确性与局限性、GGN的淋巴结清扫、恶性GGN的术后随访，均是外科治疗的热点问题。外科诊治在GGN的管理中占据着越来越重要的作用，本文将回顾现有的GGN相关研究，对恶性GGN外科诊断与治疗作一小结。

ABSTRACT

In recent years, with the development of imaging technology, more and more ground-glass Nodule (GGN) in the lungs have been discovered. After GGN is detected, it should be further judged whether it is benign or malignant by combining with existing inspection methods. Common diagnostic and examination methods include PET/CT, fiberoptic bronchoscopy, CT-guided puncture biopsy and High Resolution CT (HRCT), each of them with its own advantages and disadvantages. For GGN with high malignant risk, minimally invasive surgical intervention is needed to prevent the progress of the disease. The hot issues of surgical treatment include the selection of minimally invasive surgical methods, the precise positioning of GGN in the lung, the accuracy and limitations of intraoperative freezing examination, lymph node dissection of GGN, and postoperative follow-up of malignant GGN diagnosed as cancer. Under the premise that surgical diagnosis and treatment play an increasingly important role in the management of GGN, this paper will review the existing GGN related studies and make a summary of the surgical diagnosis and treatment of malignant GGN.

Fu Maoyong Email: mocdef.3ab61dmgnoyoamuf
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引用本文

程良,江中辉,高薇,等. 肺部恶性磨玻璃结节的外科诊治现状[J]. 中华胸心血管外科杂志,2019,35(12)：763-768.

DOI:10.3760/cma.j.issn.1001-4497.2019.12.014

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伴随着高分辨率CT(computed tomography，CT)的普及，越来越多的肺部磨玻璃结节(Ground glass nodules，GGN)被发现。肺部磨玻璃结节(ground glass nodule, GGN)是指计算机断层扫描上边界清楚或不清楚的肺内密度增高影，其病变密度不足以掩盖其中走行的血管和支气管影 [ 1 ]。根据GGN内部所含实性成分的多少，可分为两个主要类型 [ 2 ]：(1)纯GGN(pGGN)，内部无实性成分；(2)混合性GGN/部分实性GGN(mGGN)，既有纯的磨玻璃样变，又有实性成分。对于持续存在的GGN，pGGN恶性率为18%，mGGN恶性率可达63% [ 3 ]。所以需要高度警惕GGN为恶性病变的可能。
恶性GGN的病理类型均为腺癌 [ 4 ]。2011年国际肺癌研究协会/美国胸科学会/欧洲呼吸学会(IASLC/ATS/ERS)提出了腺癌的分类及诊断标准 [ 5 ]。2015年发布的WHO肺腺癌分型 [ 6 ]完全按照该标准执行，肺腺癌被分为：非典型腺瘤样增生(atypical adenomatoid hyperplasia，AAH)、原位腺癌(adenocarcinoma in situ，AIS)、微浸润腺癌(minimally invasive carcinoma，MIA)及浸润性腺癌(invasive carcinoma，IA)。恶性GGN作为肺腺癌的早期阶段，进行积极的外科干预，其预后极为理想。非浸润型腺癌(AAH、AIS)的5年生存率均为100% [ 5 ]；即使是恶性程度最高的有乳头成分的IA，其5年生存率也可达79%以上 [ 7 ]。因此，尽早识别恶性GGN，采取有效的外科治疗，能给患者带来最大的生存获益。
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