以磨玻璃结节为表现的肺腺癌亚肺叶切除研究综述

doi:10.3969/j.issn.1674-8115.2024.07.014

摘要/Abstract

摘要：

手术是肺癌的主要治疗方式。长期以来，肺叶切除术被认为是治疗局部肺癌的标准术式，而亚肺叶切除术，包括肺楔形切除术与肺段切除术，通常只是一种替代术式，应用于无法耐受根治性手术的患者。然而，随着计算机断层扫描在临床中的广泛应用，肺磨玻璃结节的检出频率不断升高，而这一外科标准也逐渐发生了改变。在持续存在的肺结节中，磨玻璃影（ground glass opacity，GGO）通常预示着良好的预后，通常对应着不典型腺瘤样增生、原位腺癌或以附壁生长型模式为主要成分的腺癌等病理改变。大量的回顾性研究表明，对于这类病灶，亚肺叶切除术能够取得令人满意的治疗效果。来自日本的一系列前瞻性研究证实了对于GGO主导的早期肺癌，亚肺叶切除术同样是一种可选择的根治性手术方案。随访数据表明，这部分患者术后的生存状况与肺叶切除术相比无统计学差异。该文综述了影像学上表现为GGO的肺腺癌的亚肺叶切除研究进展。

关键词: 非小细胞肺癌, 肺腺癌, 肺磨玻璃结节, 亚肺叶切除术

Abstract:

Surgery is the mainstay of lung cancer treatment options. Traditionally, lobectomy has held its place as the gold standard for treating localized lung cancer, while sublobar resection, including wedge resection and segmentectomy, was primarily considered as an alternative, often reserved for patient ineligible to sustain a radical intervention. However, with the widespread application of computed tomography (CT) to clinical practice, the increasing detection rate of pulmonary ground glass nodules (GGNs) has reshaped this landscape. Ground glass opacity (GGO) in persistent lung nodules is an indicative factor of a favorable prognosis, typically corresponding to pathological changes such as atypical adenomatous hyperplasia (AAH), adenocarcinoma in situ (AIS), or adenocarcinomas predominantly featuring a lepidic growth pattern. A large number of retrospective studies have shown that sublobar resection can achieve satisfactory therapeutic outcomes for such lesions. A series of prospective studies from Japan have confirmed that for early-stage lung cancers dominated by GGOs, sublobar resection is also a viable curative surgical option. The follow-up data showed that there was no statistical difference in the survival status of these patients compared with that of pulmonary lobectomy. This article aims to delve into the role of limited lung resection in the context of lung adenocarcinoma presenting with GGO features.

Key words: non-small cell lung cancer, lung adenocarcinoma, pulmonary ground-glass nodule, sublobar resection

中图分类号:

R734.2

朱鸣阳, 许元元, 任江浩, 黄嘉正, 李若楠, 谭强. 以磨玻璃结节为表现的肺腺癌亚肺叶切除研究综述[J]. 上海交通大学学报（医学版）, 2024, 44(7): 922-927.

ZHU Mingyang, XU Yuanyuan, REN Jianghao, HUANG Jiazheng, LI Ruonan, TAN Qiang. Review of sublobar resection for lung adenocarcinoma with ground-glass presence[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2024, 44(7): 922-927.

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