同期雙側單孔胸腔鏡切除肺多發磨玻璃影的單中心經驗_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

屈日榮 , 郝志鵬 , 彭澍 , 平偉 , 喻鈞 , 張霓 ,  付向寧

華中科技大學同濟醫學院附屬同濟醫院胸外科（武漢 430030）;

Corresponding?author：

付向寧, Email: fuxn2006@aliyun.com

Keywords：

肺磨玻璃影; 多發肺結節; 同期雙側手術; 單孔; 電視胸腔鏡手術

DOI：

10.7507/1007-4848.201912079

Video：

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目的總結雙肺多發磨玻璃影（ground-glass opacity，GGO）患者同期行雙側單孔胸腔鏡手術切除的經驗。方法回顧性分析 2015 年 5 月至 2019 年 10 月同期行雙側單孔胸腔鏡肺 GGO 切除 34 例患者的臨床資料，其中男 6 例、女 28 例，平均年齡 41～69（57.9±6.7）歲。結果術中平均出血量（120.9±67.7）mL，平均手術時間（140.0±74.8）min，術后平均胸腔引流時間（4.8±3.1）d，術后平均住院時間（7.2±4.3）d。術后并發癥包括肺部感染 2 例，心房顫動 3 例，肺持續漏氣>3 d 5 例，經治療后均好轉，無圍手術期嚴重并發癥及死亡病例。共切除 GGO 病灶 76 個，總惡性率為 81.6%，其中純 GGO 40 個，惡性 28 個（70.0%），平均直徑（9.6±3.8）mm；混合 GGO 36 個，惡性 34 個（94.4%），平均直徑（15.6±6.6）mm。平均隨訪時間 38.4 個月，未發現術后轉移及復發。結論雙肺多發 GGO 患者的病灶為惡性可能性大，在肺功能允許時可考慮同期雙側單孔胸腔鏡多病灶切除，根據病灶位置、大小及術中快速病理結果可靈活采取亞肺葉或肺葉切除方法。雙側同期手術安全可行，不會增加術后并發癥風險，短期預后良好。

Citation： 屈日榮, 郝志鵬, 彭澍, 平偉, 喻鈞, 張霓, 付向寧. 同期雙側單孔胸腔鏡切除肺多發磨玻璃影的單中心經驗. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(8): 948-952. doi: 10.7507/1007-4848.201912079 Copy

1.	Hansell DM, Bankier AA, MacMahon H, et al. Fleischner Society: glossary of terms for thoracic imaging. Radiology, 2008, 246(3): 697-722.
2.	Chang B, Hwang JH, Choi YH, et al. Natural history of pure ground-glass opacity lung nodules detected by low-dose CT scan. Chest, 2013, 143(1): 172-178.
3.	Moon Y, Sung SW, Lee KY, et al. Pure ground-glass opacity on chest computed tomography: predictive factors for invasive adenocarcinoma. J Thorac Dis, 2016, 8(7): 1561-1570.
4.	Bak SH, Lee HY, Kim JH, et al. Quantitative CT scanning analysis of pure ground-glass opacity nodules predicts further CT scanning change. Chest, 2016, 149(1): 180-191.
5.	Park CM, Goo JM, Lee HJ, et al. Nodular ground-glass opacity at thin-section CT: histologic correlation and evaluation of change at follow-up. Radiographics, 2007, 27(2): 391-408.
6.	Travis WD, Brambilla E, Noguchi M, et al. International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society international multidisciplinary classification of lung adenocarcinoma. J Thorac Oncol, 2011, 6(2): 244-285.
7.	Lee HY, Choi YL, Lee KS, et al. Pure ground-glass opacity neoplastic lung nodules: histopathology, imaging, and management. AJR Am J Roentgenol, 2014, 202(3): W224-W233.
8.	National Lung Screening Trial Research Team, Church TR, Black WC, et al. Results of initial low-dose computed tomographic screening for lung cancer. N Engl J Med, 2013, 368(21): 1980-1991.
9.	Nakata M, Sawada S, Yamashita M, et al. Surgical treatments for multiple primary adenocarcinoma of the lung. Ann Thorac Surg, 2004, 78(4): 1194-1199.
10.	Kocaturk CI, Gunluoglu MZ, Cansever L, et al. Survival and prognostic factors in surgically resected synchronous multiple primary lung cancers. Eur J Cardiothorac Surg, 2011, 39(2): 160-166.
11.	Jiang L, He J, Shi X, et al. Prognosis of synchronous and metachronous multiple primary lung cancers: systematic review and meta-analysis. Lung Cancer, 2015, 87(3): 303-310.
12.	張瑞杰, 蔡奕欣, 張霓, 等. 3 cm 單孔胸腔鏡在解剖性肺段切除術中的應用. 中國微創外科雜志, 2016, 16(1): 50-52.
13.	Iino K, Oda M, Tsunezuka Y, et al. Treatment for bilateral multiple lung cancers. Kyobu Geka, 2002, 55(6): 443-448.
14.	Yao F, Yang H, Zhao H. Single-stage bilateral pulmonary resections by video-assisted thoracic surgery for multiple small nodules. J Thorac Dis, 2016, 8(3): 469-475.
15.	Zhang Y, Wang Y, Lv C, et al. Clinical analysis of 56 cases of simultaneous bilateral video-assisted thoracoscopic surgery for bilateral synchronous multiple primary lung adenocarcinoma. J Thorac Dis, 2018, 10(12): 6452-6457.
16.	肖海波, 蔣連勇, 謝曉, 等. 胸腔鏡下雙肺多發結節同期手術治療. 中國胸心血管外科臨床雜志, 2018, 25(9): 750-754.
17.	Miller DL, Rowland CM, Deschamps C, et al. Surgical treatment of non-small cell lung cancer 1 cm or less in diameter. Ann Thorac Surg, 2002, 73(5): 1545-1550.
18.	付圣靈, 樊曉武, 平偉, 等. 雙側同期小單孔 VATS 與傳統 VATS 對 MG 治療的對比研究. 中華胸心血管外科雜志, 2017, 33(3): 137-140.
19.	張九江, 楊志廣, 劉韻鵬, 等. 單孔胸腔鏡治療雙側同期多發肺腺癌 1 例. 中華老年多器官疾病雜志, 2019, 18(1): 54-55.
20.	梁寶磊, 魏豪, 石珂, 等. 劍突下單孔胸腔鏡與雙側單孔胸腔鏡治療手汗癥對比研究. 中華胸部外科電子雜志, 2019, 6(3): 161-165.
21.	梁寶磊, 蔡慶勇, 梁貴友, 等. 劍突下單孔胸腔鏡與雙側單孔胸腔鏡同期處理雙側肺大皰的對比研究. 中國微創外科雜志, 2018, 18(10): 881-884.
22.	Lee HY, Lee KS. Ground-glass opacity nodules: histopathology, imaging evaluation, and clinical implications. J Thorac Imaging, 2011, 26(2): 106-118.
23.	Shimada Y, Saji H, Otani K, et al. Survival of a surgical series of lung cancer patients with synchronous multiple ground-glass opacities, and the management of their residual lesions. Lung Cancer, 2015, 88(2): 174-180.
24.	Chen K, Chen W, Cai J, et al. Favorable prognosis and high discrepancy of genetic features in surgical patients with multiple primary lung cancers. J Thorac Cardiovasc Surg, 2018, 155(1): 371-379.
25.	Dai L, Yang HL, Yan WP, et al. The equivalent efficacy of multiple operations for multiple primary lung cancer and a single operation for single primary lung cancer. J Thorac Dis, 2016, 8(5): 855-861.
26.	Detterbeck FC, Marom EM, Arenberg DA, et al. The IASLC Lung Cancer Staging Project: background data and proposals for the application of TNM staging rules to lung cancer presenting as multiple nodules with ground glass or lepidic features or a pneumonic type of involvement in the forthcoming eighth edition of the TNM classification. J Thorac Oncol, 2016, 11(5): 666-680.
27.	Naidich DP, Bankier AA, MacMahon H, et al. Recommendations for the management of subsolid pulmonary nodules detected at CT: a statement from the Fleischner Society. Radiology, 2013, 266(1): 304-317.
28.	Zhang Y, Hu H, Wang R, et al. Synchronous non-small cell lung cancers: diagnostic yield can be improved by histologic and genetic methods. Ann Surg Oncol, 2014, 21(13): 4369-4374.

1. Hansell DM, Bankier AA, MacMahon H, et al. Fleischner Society: glossary of terms for thoracic imaging. Radiology, 2008, 246(3): 697-722.
2. Chang B, Hwang JH, Choi YH, et al. Natural history of pure ground-glass opacity lung nodules detected by low-dose CT scan. Chest, 2013, 143(1): 172-178.
3. Moon Y, Sung SW, Lee KY, et al. Pure ground-glass opacity on chest computed tomography: predictive factors for invasive adenocarcinoma. J Thorac Dis, 2016, 8(7): 1561-1570.
4. Bak SH, Lee HY, Kim JH, et al. Quantitative CT scanning analysis of pure ground-glass opacity nodules predicts further CT scanning change. Chest, 2016, 149(1): 180-191.
5. Park CM, Goo JM, Lee HJ, et al. Nodular ground-glass opacity at thin-section CT: histologic correlation and evaluation of change at follow-up. Radiographics, 2007, 27(2): 391-408.
6. Travis WD, Brambilla E, Noguchi M, et al. International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society international multidisciplinary classification of lung adenocarcinoma. J Thorac Oncol, 2011, 6(2): 244-285.
7. Lee HY, Choi YL, Lee KS, et al. Pure ground-glass opacity neoplastic lung nodules: histopathology, imaging, and management. AJR Am J Roentgenol, 2014, 202(3): W224-W233.
8. National Lung Screening Trial Research Team, Church TR, Black WC, et al. Results of initial low-dose computed tomographic screening for lung cancer. N Engl J Med, 2013, 368(21): 1980-1991.
9. Nakata M, Sawada S, Yamashita M, et al. Surgical treatments for multiple primary adenocarcinoma of the lung. Ann Thorac Surg, 2004, 78(4): 1194-1199.
10. Kocaturk CI, Gunluoglu MZ, Cansever L, et al. Survival and prognostic factors in surgically resected synchronous multiple primary lung cancers. Eur J Cardiothorac Surg, 2011, 39(2): 160-166.
11. Jiang L, He J, Shi X, et al. Prognosis of synchronous and metachronous multiple primary lung cancers: systematic review and meta-analysis. Lung Cancer, 2015, 87(3): 303-310.
12. 張瑞杰, 蔡奕欣, 張霓, 等. 3 cm 單孔胸腔鏡在解剖性肺段切除術中的應用. 中國微創外科雜志, 2016, 16(1): 50-52.
13. Iino K, Oda M, Tsunezuka Y, et al. Treatment for bilateral multiple lung cancers. Kyobu Geka, 2002, 55(6): 443-448.
14. Yao F, Yang H, Zhao H. Single-stage bilateral pulmonary resections by video-assisted thoracic surgery for multiple small nodules. J Thorac Dis, 2016, 8(3): 469-475.
15. Zhang Y, Wang Y, Lv C, et al. Clinical analysis of 56 cases of simultaneous bilateral video-assisted thoracoscopic surgery for bilateral synchronous multiple primary lung adenocarcinoma. J Thorac Dis, 2018, 10(12): 6452-6457.
16. 肖海波, 蔣連勇, 謝曉, 等. 胸腔鏡下雙肺多發結節同期手術治療. 中國胸心血管外科臨床雜志, 2018, 25(9): 750-754.
17. Miller DL, Rowland CM, Deschamps C, et al. Surgical treatment of non-small cell lung cancer 1 cm or less in diameter. Ann Thorac Surg, 2002, 73(5): 1545-1550.
18. 付圣靈, 樊曉武, 平偉, 等. 雙側同期小單孔 VATS 與傳統 VATS 對 MG 治療的對比研究. 中華胸心血管外科雜志, 2017, 33(3): 137-140.
19. 張九江, 楊志廣, 劉韻鵬, 等. 單孔胸腔鏡治療雙側同期多發肺腺癌 1 例. 中華老年多器官疾病雜志, 2019, 18(1): 54-55.
20. 梁寶磊, 魏豪, 石珂, 等. 劍突下單孔胸腔鏡與雙側單孔胸腔鏡治療手汗癥對比研究. 中華胸部外科電子雜志, 2019, 6(3): 161-165.
21. 梁寶磊, 蔡慶勇, 梁貴友, 等. 劍突下單孔胸腔鏡與雙側單孔胸腔鏡同期處理雙側肺大皰的對比研究. 中國微創外科雜志, 2018, 18(10): 881-884.
22. Lee HY, Lee KS. Ground-glass opacity nodules: histopathology, imaging evaluation, and clinical implications. J Thorac Imaging, 2011, 26(2): 106-118.
23. Shimada Y, Saji H, Otani K, et al. Survival of a surgical series of lung cancer patients with synchronous multiple ground-glass opacities, and the management of their residual lesions. Lung Cancer, 2015, 88(2): 174-180.
24. Chen K, Chen W, Cai J, et al. Favorable prognosis and high discrepancy of genetic features in surgical patients with multiple primary lung cancers. J Thorac Cardiovasc Surg, 2018, 155(1): 371-379.
25. Dai L, Yang HL, Yan WP, et al. The equivalent efficacy of multiple operations for multiple primary lung cancer and a single operation for single primary lung cancer. J Thorac Dis, 2016, 8(5): 855-861.
26. Detterbeck FC, Marom EM, Arenberg DA, et al. The IASLC Lung Cancer Staging Project: background data and proposals for the application of TNM staging rules to lung cancer presenting as multiple nodules with ground glass or lepidic features or a pneumonic type of involvement in the forthcoming eighth edition of the TNM classification. J Thorac Oncol, 2016, 11(5): 666-680.
27. Naidich DP, Bankier AA, MacMahon H, et al. Recommendations for the management of subsolid pulmonary nodules detected at CT: a statement from the Fleischner Society. Radiology, 2013, 266(1): 304-317.
28. Zhang Y, Hu H, Wang R, et al. Synchronous non-small cell lung cancers: diagnostic yield can be improved by histologic and genetic methods. Ann Surg Oncol, 2014, 21(13): 4369-4374.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

同期雙側單孔胸腔鏡切除肺多發磨玻璃影的單中心經驗

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