目的 探索胸腔镜治疗单发肺转移瘤(single-pulmonary metastatic tumor,SPMT)患者的恰当术式.方法 回顾性分析本院2018年1月至2020年12月间行胸腔镜肺转移瘤切除术(video-assisted pulmonary metastasectomy,VAPM)治疗的132例SPMT患者的一般临床资料和术后病理检查结果.对原发肿瘤类型、病灶大小、Ki-67指数、切除边缘是否阳性和是否发生局部浸润进行分析.结果 132例SPMT患者中,男性78例(59.1％),女性54例(40.9％);年龄(62.0±6.8)岁.解剖性VAPM术式37例(28.0％),非解剖性VAPM术式95例(72.0％).两组术式的手术用时和术中出血量比较,差异均具有统计学意义(均P＜0.01);住院日比较,差异无统计学意义(P＞0.05).术后病理报告PMT源自甲状腺癌3例(2.3％)、乳腺癌19例(14.4％)、消化系统恶性肿瘤39例(29.5％)、泌尿系统恶性肿瘤48例(36.4％)、生殖系统恶性肿瘤11例(8.3％)和软组织肉瘤等其他组织来源恶性肿瘤12例(9.1％).PMT局部浸润30例(22.7％).脉管浸润和胸膜浸润在两个术式亚组间和不同原发肿瘤类型组间比较,差异均具有统计学意义(均P＜0.01).多因素logistic回归分析显示,PMT影像学最大径(OR=4.663,95％CI:3.191～6.325,P＜0.01)和病理类型(OR=2.408,95％CI:1.707～2.917,P＜0.05)是PMT发生局部浸润的独立影响因素;而 PMT 影像学最大径(OR=2.294,95％CI:1.271～3.870,P＜0.05)和位置(OR=4.358,95％CI:2.294～6.495,P＜0.01)是术式选择的独立影响因素.受试者操作特征(receiver operating characteristic,ROC)曲线分析获得选择解剖性术式的PMT影像学最大径的截断值为15.5 mm,特异度为82.1％,敏感度为62.2％.结论 VAPM是治疗SPMT患者安全且有效的方法.PMT影像学最大径是选择解剖性/非解剖性VAPM术式重要但不是唯一因素,应该重视原发肿瘤的病理类型及其特性.
Objective To explore the appropriate operation of video-assisted pulmonary metastasectomy(VAPM)for patients with sin-gle-pulmonary metastatic tumor(SPMT).Methods The postoperative pathological results and other clinical data of 132 patients with SPMT who underwent VAPM at our hospital from January 2018 to December 2020 were retrospectively studied.The type of primary tu-mors,lesion size,Ki-67 index,positive resection margin,and local infiltration of the patients were analyzed.Results There were 78 male patients(59.1％)and 54 female patients(40.9％),with an average age of(62.0±6.8)years.Anatomical VAPM was performed in 37 cases(28.0％),and non-anatomical VAPM was performed in 95 cases(72.0％).There were statistically significant differences in operation du-ration and intraoperative blood loss between the two groups(both P＜0.0 1),but no statistically significant differences in hospitalization time(P＞0.05).Postoperative pathological reports showed that PMT originated from thyroid cancer in three cases(2.3％),breast cancer in 19 cas-es(14.4％),digestive system malignant tumors in 39 cases(29.5％),urinary system malignant tumors in 48 cases(36.4％),reproductive sys-tem malignant tumors in 11 cases(8.3％),and soft tissue sarcoma and other tissue malignant tumors in 12 cases(9.1％).A total of 30 cases(22.7％)of local infiltration were observed.There were statistically significant differences in vascular infiltration and pleural infiltration between the patients undergoing two different surgical procedures and among the patients with different primary tumor types(both P＜0.01).The maximum diameter of PMT imaging(OR=4.663,95％CI:3.191-6.325,P＜0.01)and pathological type(OR=2.408,95％CI:1.707-2.917,P＜0.05)were independent influencing factors for the occurrence of local infiltration in PMT.The maximum diameter of PMT imaging(OR=2.294,95％CI:1.271-3.870,P＜0.05)and PMT position(OR=4.358,95％CI:2.294-6.495,P＜0.01)were independent influencing factors for surgical selection.The cut-off value of the maximum diameter of PMT imaging for anatomical VAPM selection was 15.5 mm,with a specificity of 82.1％and a sensitivity of 62.2％.Conclusions VAPM is a safe and effective treatment for patients with SPMT.The maximum diameter of PMT imaging is an important but not the only factor in selecting anatomical or non-anatomical VAPM.The patholog-ical characteristics of primary tumors is an important factor to be considered.
苏雷;王腾腾;高艳;李元博;王雷明
首都医科大学宣武医院胸外科,北京 100053首都医科大学宣武医院放射科,北京 100053首都医科大学宣武医院病理科,北京 100053
单发肺转移瘤;胸腔镜肺转移瘤切除术;术后病理
single-pulmonary metastatic tumor;video-assisted pulmonary metastasectomy;postoperative pathology
《实用肿瘤杂志》 2024 (003)
236-241 / 6
973国家科技计划项目(2011CB510100)
10.13267/j.cnki.syzlzz.2024.036
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