Congregado Loscertales M, Girón Arjona J C, Jiménez Merchán R, Arroyo Tristán A, Arenas Linares C, Ayarra Jarne J, Loscertales J
Servicio de Cirugía General y Torácica, Hospital Universitario Virgen Macarena, Sevilla, Spain.
Arch Bronconeumol. 2002 Sep;38(9):415-20. doi: 10.1016/s0300-2896(02)75254-x.
Various approaches are used for the diagnosis and treatment of solitary pulmonary nodules (SPN) of unknown origin. New imaging techniques and nuclear medicine have provided more information about SPN, but surgical removal is still the most sensitive and specific way to obtain a correct analysis of the lesion. With video-assisted thoracic surgery (VATS), a histological diagnosis can be obtained without resorting to thoracotomy. In the present study we describe our experience with the diagnosis and treatment of SPN using VATS.
From July 1992 through April 2001, 182 patients were operated on for SPN in our department.
Retrospective study. Mean age: 59.2 years (12-78). Sex: 39 women and 143 men. Localization: Visual or instrumental exploration in 102 patients, with palpation in 52 cases and using a hookwire guided by preoperative computed tomography in 25 (with failure in 4 of those cases). Tissue was biopsied during surgery and when the lesion was malignant, oncological excision was performed during the same operation.
A firm diagnosis was obtained by VATS for 178 patients (98.3%). For three other patients the surgeon had to take a needle biopsy (Tru-cut) during surgery, and in one case conversion to open surgery was necessary. Histopathology: hamartoma: 11; fibrous nodule: 10; bronchiolitis obliterans: 1; pneumoconiosis: 1; mesenchymal tumor: 3; inflammatory pseudotumor: 14; mucormycosis: 1; tuberculoma:17; lymphoma: 1; carcinoid tumor: 6; metastasis: 22; bronchogenic carcinoma: 95. Mortality was 0.55%, with 1 patient dying from massive pulmonary thromboembolism. Morbidity was 5%, from 9 minor complications.
VATS is an effective approach, with low morbidity and mortality. We consider it to be the technique of choice for the diagnosis of all SPN and for the treatment of some, such as benign nodules and solitary metastases.
对于不明原因的孤立性肺结节（SPN），采用了多种诊断和治疗方法。新的成像技术和核医学提供了更多关于SPN的信息，但手术切除仍然是对病变进行正确分析的最敏感和特异的方法。借助电视辅助胸腔镜手术（VATS），无需开胸即可获得组织学诊断。在本研究中，我们描述了使用VATS诊断和治疗SPN的经验。
1992年7月至2001年4月，我科对182例SPN患者进行了手术。
回顾性研究。平均年龄：59.2岁（12 - 78岁）。性别：女性39例，男性143例。定位：102例患者通过视觉或器械探查，52例通过触诊，25例在术前计算机断层扫描引导下使用钩丝定位（其中4例失败）。手术中对组织进行活检，若病变为恶性，则在同一手术中进行肿瘤切除。
178例患者（98.3%）通过VATS获得了明确诊断。另外3例患者外科医生在手术中不得不进行针吸活检（Tru - cut），1例患者需要转为开胸手术。组织病理学结果：错构瘤11例；纤维结节10例；闭塞性细支气管炎1例；尘肺1例；间叶组织肿瘤3例；炎性假瘤14例；毛霉菌病1例；结核瘤17例；淋巴瘤1例；类癌肿瘤6例；转移瘤22例；支气管肺癌95例。死亡率为0.55%，1例患者死于大面积肺血栓栓塞。发病率为5%，由9例轻微并发症引起。
VATS是一种有效的方法，发病率和死亡率低。我们认为它是所有SPN诊断以及某些类型（如良性结节和孤立性转移瘤）治疗的首选技术。
