同期双侧单孔胸腔镜切除肺多发磨玻璃影的单中心经验_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

屈日荣 , 郝志鹏 , 彭澍 , 平伟 , 喻钧 , 张霓 ,  付向宁

华中科技大学同济医学院附属同济医院胸外科（武汉 430030）;

Corresponding author：

付向宁, Email: fuxn2006@aliyun.com

Keywords：

肺磨玻璃影; 多发肺结节; 同期双侧手术; 单孔; 电视胸腔镜手术

DOI：

10.7507/1007-4848.201912079

Video：

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目的总结双肺多发磨玻璃影（ground-glass opacity，GGO）患者同期行双侧单孔胸腔镜手术切除的经验。方法回顾性分析 2015 年 5 月至 2019 年 10 月同期行双侧单孔胸腔镜肺 GGO 切除 34 例患者的临床资料，其中男 6 例、女 28 例，平均年龄 41～69（57.9±6.7）岁。结果术中平均出血量（120.9±67.7）mL，平均手术时间（140.0±74.8）min，术后平均胸腔引流时间（4.8±3.1）d，术后平均住院时间（7.2±4.3）d。术后并发症包括肺部感染 2 例，心房颤动 3 例，肺持续漏气>3 d 5 例，经治疗后均好转，无围手术期严重并发症及死亡病例。共切除 GGO 病灶 76 个，总恶性率为 81.6%，其中纯 GGO 40 个，恶性 28 个（70.0%），平均直径（9.6±3.8）mm；混合 GGO 36 个，恶性 34 个（94.4%），平均直径（15.6±6.6）mm。平均随访时间 38.4 个月，未发现术后转移及复发。结论双肺多发 GGO 患者的病灶为恶性可能性大，在肺功能允许时可考虑同期双侧单孔胸腔镜多病灶切除，根据病灶位置、大小及术中快速病理结果可灵活采取亚肺叶或肺叶切除方法。双侧同期手术安全可行，不会增加术后并发症风险，短期预后良好。

Citation： 屈日荣, 郝志鹏, 彭澍, 平伟, 喻钧, 张霓, 付向宁. 同期双侧单孔胸腔镜切除肺多发磨玻璃影的单中心经验. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(8): 948-952. doi: 10.7507/1007-4848.201912079 Copy

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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. 张瑞杰, 蔡奕欣, 张霓, 等. 3 cm 单孔胸腔镜在解剖性肺段切除术中的应用. 中国微创外科杂志, 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, 蒋连勇, 谢晓, 等. 胸腔镜下双肺多发结节同期手术治疗. 中国胸心血管外科临床杂志, 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. 付圣灵, 樊晓武, 平伟, 等. 双侧同期小单孔 VATS 与传统 VATS 对 MG 治疗的对比研究. 中华胸心血管外科杂志, 2017, 33(3): 137-140.
19. 张九江, 杨志广, 刘韵鹏, 等. 单孔胸腔镜治疗双侧同期多发肺腺癌 1 例. 中华老年多器官疾病杂志, 2019, 18(1): 54-55.
20. 梁宝磊, 魏豪, 石珂, 等. 剑突下单孔胸腔镜与双侧单孔胸腔镜治疗手汗症对比研究. 中华胸部外科电子杂志, 2019, 6(3): 161-165.
21. 梁宝磊, 蔡庆勇, 梁贵友, 等. 剑突下单孔胸腔镜与双侧单孔胸腔镜同期处理双侧肺大疱的对比研究. 中国微创外科杂志, 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

同期双侧单孔胸腔镜切除肺多发磨玻璃影的单中心经验

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