外科治疗叶间胸膜下近肺门肺结节的前瞻性单臂研究

吴雯丽; 宋庆平; 耿东晓; 赵燕风; 陈海泉; 于秋凤; 姜峰

doi:10.19401/j.cnki.1007-3639.2025.04.009

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外科治疗叶间胸膜下近肺门肺结节的前瞻性单臂研究

论著 | 更新时间：2025-12-31

- 外科治疗叶间胸膜下近肺门肺结节的前瞻性单臂研究
- A prospective single-arm study on surgical treatment of pulmonary nodules located beneath the interlobar pleura and adjacent to the pulmonary hilum
- 中国癌症杂志 2025年35卷第4期页码：412-417
- 作者机构：
  
  1. 山东省聊城市肿瘤防治院影像中心，山东聊城 252000
  2. 山东省聊城市肿瘤防治院胸外科，山东聊城 252000
  3. 国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院影像诊断科，北京 100021
  4. 复旦大学附属肿瘤医院胸外科，复旦大学上海医学院肿瘤学系，上海 200032
- 作者简介：
  
  [ "吴雯丽（0009-0000-3970-9197），副主任医师，CT室副主任；" ]
  [ "并列第一作者：宋庆平（0009-0000-0264-2566），副主任医师，胸外科主任。" ]
  姜峰（0000-0001-6184-4491），副主任医师，胸外科副主任。
- 基金信息：
  
  聊城市重点研发计划政策引导类项目(2023YD64)
- DOI：10.19401/j.cnki.1007-3639.2025.04.009
  中图分类号：
- 收稿：2025-01-13，
  
  修回：2025-04-04，
  
  纸质出版：2025-04-30
- 稿件说明：
移动端阅览
吴雯丽, 宋庆平, 耿东晓, 等. 外科治疗叶间胸膜下近肺门肺结节的前瞻性单臂研究[J]. 中国癌症杂志, 2025,35(4):412-417.

Wenli WU, Qingping SONG, Dongxiao GENG, et al. A prospective single-arm study on surgical treatment of pulmonary nodules located beneath the interlobar pleura and adjacent to the pulmonary hilum[J]. China Oncology, 2025, 35(4): 412-417.
吴雯丽, 宋庆平, 耿东晓, 等. 外科治疗叶间胸膜下近肺门肺结节的前瞻性单臂研究[J]. 中国癌症杂志, 2025,35(4):412-417. DOI： 10.19401/j.cnki.1007-3639.2025.04.009.

Wenli WU, Qingping SONG, Dongxiao GENG, et al. A prospective single-arm study on surgical treatment of pulmonary nodules located beneath the interlobar pleura and adjacent to the pulmonary hilum[J]. China Oncology, 2025, 35(4): 412-417. DOI： 10.19401/j.cnki.1007-3639.2025.04.009.

摘要

背景与目的：

准确定位肺结节是胸腔镜手术成功的关键。本研究旨在探讨胸腔镜下外科手术治疗位于叶间胸膜下近肺门特殊位置肺结节的策略并评估其可行性、安全性及临床价值。

方法：

本研究收集2023年5月—2024年11月在聊城市肿瘤防治院行肺结节外科手术的患者，对于不符合纳入标准的患者予以排除。本研究获聊城市肿瘤防治院伦理委员会批准（伦理编号：EC-20240112-1020）且获得患者知情同意。本研究是前瞻性单臂研究，对纳入的患者采取CT引导下经叶间胸膜穿刺定位肺结节的非常规穿刺定位方式，进而对其行楔形切除术，评价术前CT引导下定位术的成功率及并发症发生率，分析围手术期并发症，验证此类手术方式的可行性。

结果：

本研究共纳入28例符合入组标准的患者。男性5例，女性23例，年龄38~69岁，平均（56.0±8.5）岁。对28例患者合计28个结节行胸腔镜楔形切除术，术前CT引导下定位全部成功（100.0%），无需要紧急处理的并发症。胸腔镜手术平均时间为（15.6±4.0） min；术中出血（20.9±14.3）mL，术后引流（214.3±62.2） mL，漏气0例，中转开胸手术0例；住院平均时间为（5.4±0.9）d。肺结节术后病理学检查结果为良性的患者有3例，其中肺组织纤维化2例，非典型腺瘤样增生1例；恶

性有25例，其中原位腺癌5例，微浸润性腺癌16例，浸润性腺癌4例。

结论：

通过CT引导下经过叶间胸膜定位肺结节并行胸腔镜楔形切除，既可保证手术切除的准确性，最大可能地切除肿瘤，同时又避免了肺段或者肺叶切除造成正常肺组织损失，安全快捷，对于此类特殊位置肺结节的手术治疗具有重要的指导意义。

Abstract

Background and purpose:

Accurately locating pulmonary nodules is the key to the success of thoracoscopic surgery. This study aimed to investigate the strategy and evaluate the feasibility

safety

and clinical value of thoracoscopic surgical treatment for pulmonary nodules located beneath the interlobar pleura and close to the pulmonary hilum.

Methods:

The patients who underwent pulmonary nodule surgery at Liaocheng Tumor Hospital from May 2023 to November 2024 were enrolled

and the patients who did not meet the inclusion criteria were excluded. This study was approved by the Ethics Committee of Liaocheng Tumor Hospital (EC-20240112-1020) and informed consent was obtained from the patients. The research was designed as a prospective single-arm study. The patients were treated with wedge resection

which was performed following CT-guided localization

where the location needle was inserted through the interlobar pleura. The feasibility of the procedure was evaluated by analyzing the success rate of preoperative localization and perioperative complications.

Results:

A total of 28 patients who met the inclusion criteria were included in this study. There were 5 male and 23 female patients with an average age of (56.0±8.5) years (range 38-69 years). In all

28 patients with 28 nodules underwent thoracoscopic wedge resection

and the preoperative CT-guided localization was successfully performed in all patients

without urgent complications. The mean operation time of thoracoscopic surgery was (15.6±4.0) min

intraoperative bleeding was (20.9±14.3) mL

and postoperative drainage was (214.3±62.2) mL. No cases of postoperative air leaks or conversion to thoracotomy were observed. The average length of hospital stay was (5.4±0.9) days. The po

stoperative histological diagnosis revealed 3 benign lesions (pulmonary fibrosis in 2 cases

atypical adenomatous hyperplasia in 1 case) and 25 malignant lesions (adenocarcinoma

in situ

in 5 cases

minimally invasive adenocarcinoma in 16 cases

and invasive adenocarcinoma in 4 cases).

Conclusion:

Thoracoscopic wedge resection following CT-guided nodule localization through the interlobar pleura is a feasible approach for nodules located beneath the interlobar pleura and close to the pulmonary hilum. The method ensures precise tumor localization

adequate margin

and minimal loss of normal lung tissue

with a low incidence of postoperative complication

which has important guiding significance for the surgical treatment of pulmonary nodules in such special locations.

关键词

Keywords

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