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目的:总结电视胸腔镜手术切除亚厘米(≤1 cm)非小细胞肺癌患者的临床病理特征及手术方式。方法:自2009—2015年,78例肺部亚厘米结节患者,根据术前CT表现将其分为3组,纯磨玻璃样结节(ground-glass opacity,GGO)组、混合型GGO组和实性结节组。78例患者均行电视胸腔镜下微创手术,术后病理提示为非小细胞肺癌(包括原位腺癌、微浸润癌以及浸润癌),总结其临床病理特征。结果:纯GGO及混合性GGO组均未见淋巴结转移,在实性结节组可见4例患者出现淋巴结转移,其中2例为纵隔淋巴结转移,5年生存率纯GGO组为100%,混合性GGO组为99%,实性结节组为90%。结论:胸部CT表现为GGO形态(包括纯GGO和混合性GGO)的早期肺癌患者无淋巴结转移,可行包括解剖性肺段切除及楔形切除在内的亚肺叶切除术;对于实性亚厘米结节的肺部病灶,因其存在淋巴结转移可能,肺叶切除加纵隔淋巴结系统性清扫术仍然作为首选手术方式。
OBJECTIVE: To summarize the clinicopathological features and surgical modalities of patients undergoing thoracoscopic resection of sub-centimeter (≤1 cm) non-small cell lung cancer. Methods: From 2009 to 2015, 78 patients with sub-cm lung nodules were divided into 3 groups according to their CT findings: ground-glass opacity (GGO) group, mixed GGO group And solid nodules group. All 78 patients underwent minimally invasive video-assisted thoracoscopic surgery. Postoperative pathologic findings were non-small cell lung cancer (including adenocarcinoma in situ, microinvasive carcinoma and invasive carcinoma), and their clinical and pathological features were summarized. Results: No lymph node metastasis was found in the pure GGO and mixed GGO groups. In the solid nodule group, 4 cases showed lymph node metastasis, 2 cases were mediastinal lymph node metastasis, 5-year survival rate was 100% in pure GGO group, mixed 99% in the GGO group and 90% in the solid nodule group. CONCLUSIONS: There is no lymph node metastasis in early stage lung cancer with GGO morphology (including pure GGO and mixed GGO) in chest CT, and sub-lobectomy including anatomic segmentectomy and wedge resection is feasible. For solid sub-centrilial nodules Of the lung lesions, because of their possible lymph node metastases, lobectomy and mediastinal lymph node dissection is still the preferred surgical approach.