目的 通过肺结节交互印证式诊断,提高术前影像诊断的准确率,选择合适的手术时机,指导肺小结节的随访时间.方法 回顾性分析单中心2016年7月至2019年10月厦门大学附属第一医院胸外科1 368例肺结节手术患者的临床资料,男531例、女837例,年龄44(21～67)岁.选择肺结节直径≤2 cm,术前行多学科会诊,详细阅读胸部CT,术中切开病灶剖面进行分析,快速病理诊断肺结节性质,术后常规行病理诊断.随后将肺结节影像特征、术中剖面特征与病理结果一一对照,通过两两对应,交互印证,把肺结节的影像病理及病变切面表现为一个动态变化的过程.结果 在1 368例肺小结节患者中,影像学表现为纯磨玻璃样结节的有376例(27.5％),混合性磨玻璃样结节共有729例(53.3％),实性结节共有263例(19.2％).在纯磨玻璃样结节患者中,原位腺癌(adenocarcinoma in situ,AIS)占比最高,为156例,微浸润性腺癌(microinvasive adenocarcinoma,MIA)和不典型腺瘤样增生(atypical adenomatous hyperplasia,AAH)比例相当,分别为90例和85例,其它良性肿瘤共20例.在混合性磨玻璃样结节中,浸润性腺癌(invasive adenocarcinoma,IA)共495例,其次是MIA 207例;且在实性结节中,病理结果主要为IA和其它良性肿瘤,分别为213例和50例,实性结节病理无AAH、AIS及MIA.结论 肺结节交互印证式诊断可以提高术前诊断的准确率,对选择手术时机、随访时间的判断具有重要意义.

目的 探讨移动CT(mobile CT,MCT)在肺小结节术前及术中定位中的价值.方法 2017年9月～2018年1月我们对50例62个肺小结节术前在MCT引导下用Hook-wire定位针进行肺小结节定位,根据定位行肺小结节切除术,所有肺小结节均送术中冰冻病理检查,若Hook-wire脱落或移位术中再次利用MCT扫描定位.结果 62个肺小结节术前定位成功59个,2个脱钩,1个移位,成功率95.2％(59/62),脱落、移位率4.8％(3/62),术中再次利用MCT扫描定位,最终62个肺结节病灶均成功切除.术中冰冻病理结果显示肿物距离切缘2 cm.定位时间(15.2±5.1)min.定位后少量气胸11例,肺出血1例,肋间血管出血1例,均未特殊处理.结论 MCT在肺小结节术前及术中定位准确、快速,值得推荐.

Objective To explore the clinical value of video-assisted thoracoscopic surgery(VATS)for coinstantaneous primary carcinoma of esophagus and lung. Methods A retrospective analysis was made on 17 cases of VATS for coinstantaneous primary carcinoma of esophagus and lung in our hospital from July 2005 to December 2015.The surgical approach was chosen mainly based on the location of lung lesions and intraoperative frozen-section examinations.Generally, if the preoperative lung biopsies confirmed cancer,the surgical wedge resection, pulmonary segmentectomy or pulmonary lobectomy was performed firstly, and then thoracoscopic resection of esophageal carcinoma was carried out on the right side.When preoperative lung tumor pathology was not clear,thoracoscopic pulmonary wedge or segment resection was performed,and then according to the intraoperative rapid pathological examination,segment resection with lymph node biopsy for carcinoma in situ or lobectomy with mediastinal lymph node dissection for invasive carcinoma was conducted, followed by thoracoscopic radical surgery for esophageal carcinoma on the right side. Results The concurrent operation was accomplished in all the 17 cases.One patient died of pulmonary embolism on the 7th day.The complications contained 1 case of anastomotic leakage,2 cases of hoarseness,and 1 case of lung infection, all of which were cured. Postoperative pathology results showed that 17 cases of esophageal cancer were all squamous cell carcinoma,and among the 17 cases of lung cancer there were 13 cases of adenocarcinoma,3 cases of adenosquamous carcinoma,and 1 case of small cell carcinoma.Eight patients died in the period from 12 to 36 months,with a mean survival time of 33.6 months.The other 8 patients were followed up for 12 -60 months(mean, 45.6 months). Conclusions Concurrent video-thoracoscopic surgery in the treatment of esophageal carcinoma complicated with pulmonary cancer has a good perioperative treatment effect prognosis and acceptable risks.The surgical method is safe and feasible.