Yue Hongxu, Fan Kaijie, Zhang Zhimin, Liu Yang
Postgraduate School, Medical School of Chinese PLA, Beijing 100853, China.
Department of Thoracic Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China.
Evid Based Complement Alternat Med. 2021 Aug 30;2021:1490709. doi: 10.1155/2021/1490709. eCollection 2021.
This is a retrospective research comparing the clinical outcomes of single-hole versus multi-hole video-assisted thoracoscopic surgical (VATS) resection for solitary pulmonary nodules (SPN) and examining the factors influencing the diagnosis of benign and malignant pulmonary nodules.
We collected the clinical data, surgical status, outcomes, and corresponding imaging features of 317 patients with SPN who were surgically resected by VATS and diagnosed as benign or malignant by pathology in our hospital from January 2019 to December 2021.
Among the 317 patients, 124 (39.12%) underwent single-port VATS and 193 (60.88%) underwent multiple-hole VATS. All patients were grouped according to the different surgical methods, and their postoperative indicators were statistically analyzed. The results showed that neither the single-port VATS group nor the multi-port VATS group had any serious adverse events such as death during the perioperative period. The average operation time, intraoperative blood loss, drainage tube indwelling time, and postoperative hospital stay were significantly lower in the two groups. Statistics of postoperative pathological diagnosis showed that 98 cases (30.91%) of all nodules were benign nodules and 219 cases (69.09%) were malignant nodules, and a further single-multivariate analysis showed that age, nodule maximum diameter, lobular sign, burr sign, vascular cluster sign, and pleural depression sign were independent relevant factors for the diagnosis of benign and malignant nodules.
VATS is less invasive and has fewer complications and is of great clinical value for both diagnosis and treatment of benign and malignant SPN. Age, maximum nodal diameter, lobar sign, burr sign, vascular set sign, and pleural depression sign were independent correlates affecting the diagnosis of benign and malignant SPN, which reminds that great attention should be paid to patients who are older and have risk factors on imaging, and early and timely active treatment or close follow-up should be carried out.
本研究为回顾性研究，比较单孔与多孔电视辅助胸腔镜手术（VATS）切除孤立性肺结节（SPN）的临床疗效，并探讨影响肺结节良恶性诊断的因素。
收集2019年1月至2021年12月在我院接受VATS手术切除且经病理诊断为良性或恶性的317例SPN患者的临床资料、手术情况、结局及相应影像学特征。
317例患者中，124例（39.12%）接受单孔VATS手术，193例（60.88%）接受多孔VATS手术。所有患者按不同手术方式分组，对其术后指标进行统计学分析。结果显示，单孔VATS组和多孔VATS组在围手术期均未发生死亡等严重不良事件。两组的平均手术时间、术中出血量、引流管留置时间及术后住院时间均显著降低。术后病理诊断统计显示，所有结节中98例（30.91%）为良性结节，219例（69.09%）为恶性结节，进一步的单因素和多因素分析显示，年龄、结节最大直径、分叶征、毛刺征、血管集束征及胸膜凹陷征是诊断良恶性结节的独立相关因素。
VATS具有微创、并发症少的特点，对SPN的良恶性诊断及治疗均具有重要临床价值。年龄、结节最大直径、分叶征、毛刺征、血管集束征及胸膜凹陷征是影响SPN良恶性诊断的独立相关因素，提示对于年龄较大且影像学有危险因素的患者应高度重视，尽早及时积极治疗或密切随访。
