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Diagnosis and Treatment of Bilateral Multiple Pulmonary Ground-Glass Nodules: Case-Based Discussion among Young Thoracic Surgeons in Beijing
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摘要: 以肺磨玻璃病灶为表现的多原发肺癌的发病率呈逐年上升趋势。该类疾病发生发展与经典肺癌有所不同, 其发病原因及治疗策略受到胸外科医师及患者的密切关注。本文记录了北京胸外科青年医师基于一例双肺多灶磨玻璃病变诊疗策略开展的讨论过程, 集中反映了本病诊治的关键点和人文思考。Abstract: Patients with multiple pulmonary ground-glass nodules become more common in the clinic nowadays. Pathogenesis and progression of this kind of disease are strikingly different from those of typical malignant lung tumors. Management strategy of it has been hotly discussed. Here we present a case of bilateral multiple pulmonary ground-glass nodules and the following discussion among young thoracic surgeons in Beijing.
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图 1 2015年12月患者CT示双肺肺野内见散在片状及磨玻璃样密度增高影(箭头), 边界欠清, 部分病灶内可见多发小空洞
A.右肺上叶病灶; B.右肺下叶病灶; C.右肺中叶病灶; D.左肺上叶病灶
图 2 正电子发射断层显像/计算机体层成像示双肺多发放射性摄取异常增高斑片、磨玻璃结节及空洞(箭头), 大小0.7~2.4 cm, 标准化摄取值1.3~3.8
A.双肺上叶病灶; B.右肺下叶病灶; C.右肺中上叶病灶; D.全身扫描相
表 1 患者各病灶组织病理学亚型构成比(%)
病灶 乳头状亚型 腺泡样亚型 贴壁生长 右肺上叶 50 50 - 右肺中叶 90 - - 右肺下叶 50 50 - 左肺上叶结节1 - - 90 左肺上叶结节2 50 50 - 左肺上叶结节3 - 90 - 
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