外科治疗叶间胸膜下近肺门肺结节的前瞻性单臂研究

doi:10.19401/j.cnki.1007-3639.2025.04.009

摘要/Abstract

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。

关键词: 肺结节, 楔形切除术, CT引导, 过叶间裂定位

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 postoperative 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.

Key words: Pulmonary nodules, Thoracoscopic wedge resection, CT guidance, Located through the interlobar pleura

吴雯丽, 宋庆平, 耿东晓, 赵燕风, 陈海泉, 于秋凤, 姜峰. 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.

WU Wenli, SONG Qingping, GENG Dongxiao, ZHAO Yanfeng, CHEN Haiquan, YU Qiufeng, JIANG Feng. 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.

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Characteristic	Data (n=28)
Gender
Female	23 (82.1%)
Male	5 (17.9%)
Age/year	56.0±8.5
Nodule long diameter D/cm	0.9±0.3
Nodule short diameter D/cm	0.8±0.2
Pleural depth D/cm	1.4±0.8
Location time t/min	19.0±7.4
Pneumothorax
No	20 (71.4%)
Yes	8 (28.6%)
Localization bleeding
No	16 (57.1%)
Yes	12 (42.9%)
Surgical time t/min	15.6±4.0
Intraoperative bleeding V/mL	20.9±14.3
Hospitalization time t/d	5.4±0.9
Flow rate V/mL	214.3±62.2
Pathology
Pulmonary fibrosis	2 (7.1%)
AAH	1 (3.6%)
AIS	5 (17.9%)
MIA	16 (57.1%)
IAC	4 (14.3%)