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目的总结分析孤立性肺结节(SPN)的良恶性危险因素和外科诊治经验。方法回顾性分析2008年1月至2014年5月在第三军医大学大坪医院经电视胸腔镜手术(VATS)切除并获得明确病理诊断的327例SPN患者的临床资料,其中男183例、女144例,年龄56.6(20~79)岁。结果单因素分析结果显示,年龄、吸烟指数、结节最大径、毛刺、分叶、胸膜牵拉征、空洞、血管集束征、钙化在良恶性SPN之间的差异有统计学意义(P<0.05)。多因素分析结果显示:年龄(P=0.004,OR=1.084)、结节最大径(P<0.001,OR=1.467)、毛刺(P=0.001,OR=8.754)、分叶(P<0.001,OR=10.424)、胸膜牵拉征(P=0.002,OR=6.619)是SPN的独立危险因素。全组平均手术时间(121.4±47.6)min,术中失血量(105.3±57.8)ml,术后住院时间(7.3±2.4)d,诊断准确率99.7%,中转开胸率1.5%,术中并发症发生率0.5%,无围术期死亡。结论患者年龄、结节最大径、毛刺、分叶、胸膜牵拉征是判断SPN良恶性的独立危险因素。VATS是诊治SPN的安全、有效手段。
Objective To summarize and analyze the risk factors and surgical diagnosis and treatment experience of solitary pulmonary nodules (SPN). Methods The clinical data of 327 SPN patients who underwent VATS and clear pathological diagnosis from January 2008 to May 2014 in Daping Hospital of the Third Military Medical University were retrospectively analyzed. There were 183 males and 144 females Cases, age 56.6 (20 ~ 79) years old. Results The results of univariate analysis showed that the differences of age, smoking index, the maximum diameter of nodules, burr, lobulation, pleural traction sign, cavity, clustering of blood vessels and calcification in benign and malignant SPN were statistically significant (P <0.05 ). Multivariate analysis showed that age (P = 0.004, OR = 1.084), nodule diameter (P <0.001, OR = 1.467), burr (P = 0.001, OR = 8.754) = 10.424). Pleural traction (P = 0.002, OR = 6.619) was an independent risk factor for SPN. The mean operative time (121.4 ± 47.6) min, intraoperative blood loss (105.3 ± 57.8) ml, postoperative hospital stay (7.3 ± 2.4) days, diagnostic accuracy rate of 99.7%, conversion thoracotomy rate of 1.5% Incidence rate of 0.5%, no perioperative deaths. Conclusion The age of patients, the maximum diameter of nodules, burr, lobulation and pleural traction are the independent risk factors for the diagnosis of benign and malignant SPN. VATS is a safe and effective means of diagnosis and treatment of SPN.