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1、Our greatest weakness lies in giving up The most certain way to succeed is always to try just one more time 肺经皮穿刺在肺磨玻璃结节肺经皮穿刺在肺磨玻璃结节 GGO GGO 的的 精确定位及精准切除术中的应用精确定位及精准切除术中的应用 Our greatest weakness lies in giving up The most certain way to succeed is always to try just one more time 肺癌发病情况 恶性肿瘤中 男性第一位
2、女性第二位 Our greatest weakness lies in giving up The most certain way to succeed is always to try just one more time 肺癌的致病因素 吸烟 职业接触 家族 Our greatest weakness lies in giving up The most certain way to succeed is always to try just one more time 肺癌的临床表现 刺激性干咳 痰中带血 Our greatest weakness lies in giving up
3、The most certain way to succeed is always to try just one more time 肺癌的高危人群 每日吸烟支数乘以吸烟年数 400的45岁以 上人群 Our greatest weakness lies in giving up The most certain way to succeed is always to try just one more time 检查方法 无创 胸片 胸部CT PET CT 有创 支气管镜 EBUS 纵隔镜 胸腔镜 Our greatest weakness lies in giving up The mo
4、st certain way to succeed is always to try just one more time 确诊依据 通过气管镜 胸腔镜 开胸手术等方法获取 的病灶组织 经病理证实为确诊的唯一依据 Our greatest weakness lies in giving up The most certain way to succeed is always to try just one more time 治疗的主要手段 手术 放疗 化疗 靶向治疗 Our greatest weakness lies in giving up The most certain way to
5、 succeed is always to try just one more time 治疗效果 以手术为主的综合治疗 3年生存期 一期病人 80 二期病人 40 部分三期 15 单纯放 化疗病人只可延长中位生存期2 6 个月 靶向治疗只对EGFR阳性的腺癌病人有效 可长期带瘤生存 须终生服药 费用昂贵 Our greatest weakness lies in giving up The most certain way to succeed is always to try just one more time 治疗效果最佳的方法 早期发现 高危人群每年一次胸部CT检查 出现症状后检查发
6、现肺癌 者80 为中晚 早期诊断 支气管镜活检 CT 定位经皮肺穿 胸腔镜微创病灶切除等 获取病理组织定性 早期治疗 采取手术为主的综合治疗 Our greatest weakness lies in giving up The most certain way to succeed is always to try just one more time 早期诊断中的新进展 目前随着市民健康体检意识的提高 以及CT设备的更 新换代 临床新发现的肺癌患者的临床分期日趋提前 一 些直径1cm左右甚至更小的肺部结节在临床上越来越多见 经手术切除后病理证实 肺小结节中CT影像表现为毛 玻璃样的结节 G
7、GO 80 为肺癌 Our greatest weakness lies in giving up The most certain way to succeed is always to try just one more time 什么是肺小结节 肺部病灶直径 3CM的实体瘤 肺部病灶直径 1CM的实体瘤叫微小结节 Our greatest weakness lies in giving up The most certain way to succeed is always to try just one more time 什么是GGO 肺内磨玻璃结节 GGO即为肺内磨玻璃密度影 gr
8、ound glass opacity GGO 是指高分辨率CT high resolution CT HRCT 图像上表现为密度轻度增加 但其内的支气管血管束仍可 显示 见于各种炎症 水肿 纤维化及肿瘤等病变 Our greatest weakness lies in giving up The most certain way to succeed is always to try just one more time 纯毛玻璃结节 Our greatest weakness lies in giving up The most certain way to succeed is alway
9、s to try just one more time 纯毛玻璃结节 Our greatest weakness lies in giving up The most certain way to succeed is always to try just one more time 部分磨玻璃结节 Our greatest weakness lies in giving up The most certain way to succeed is always to try just one more time 肺癌实性结节 Our greatest weakness lies in givi
10、ng up The most certain way to succeed is always to try just one more time Our greatest weakness lies in giving up The most certain way to succeed is always to try just one more time 肺小结节的处理原则 2011年国内外专家已达成共识 一 纯实性结节的 临床上不需要立即干预 对于 5mm 的微小结节通常至少每半年CT随访一次 两年内结节无 明显增大者可诊断为良性病灶 不需手术切除 而随访两年 中 发现结节明显增大时
11、应立即手术切除 二 纯GGO或部分GGO 结节多为恶性病变 尤其 GGO伴有纵隔淋巴结增大者 应在发现第一时间手术切除 手术多采用胸腔镜微创方法 对位于肺边缘的结节可做 肺段切除或楔形切除 并根据术中快速病检结果 决定是否 行根治手术 Our greatest weakness lies in giving up The most certain way to succeed is always to try just one more time 肺切手术的原则 最大限度切除病灶 最大限度保留健康肺组织 Our greatest weakness lies in giving up The m
12、ost certain way to succeed is always to try just one more time 精确定 位后 VATS下 结节切 除 快速病 理 良性病 变 手术结 束 恶性变 变 肺 癌根治 术 两个原则的结合 Our greatest weakness lies in giving up The most certain way to succeed is always to try just one more time 胸腔镜全景 Our greatest weakness lies in giving up The most certain way to
13、succeed is always to try just one more time 打孔进胸 Our greatest weakness lies in giving up The most certain way to succeed is always to try just one more time 手指触摸定位 Our greatest weakness lies in giving up The most certain way to succeed is always to try just one more time 楔形切除 Our greatest weakness l
14、ies in giving up The most certain way to succeed is always to try just one more time 楔形切除 Our greatest weakness lies in giving up The most certain way to succeed is always to try just one more time 切口对比 Our greatest weakness lies in giving up The most certain way to succeed is always to try just one
15、 more time 结节定位方法 手指触摸 CT引导下结节局部美蓝注射 乳腺定位针CT引导下穿刺定位 Our greatest weakness lies in giving up The most certain way to succeed is always to try just one more time 结节各种定位方法的优缺点 手指触摸 优势为最直 接 简便易行 无需增加额外 费用 缺点为手指长度有限 无法对 远处或肺组织深部结节进行 触摸定位 而中转开胸 加大 损伤 Our greatest weakness lies in giving up The most certai
16、n way to succeed is always to try just one more time 结节各种定位方法的优缺点 CT引导下结节局部美 蓝注射 优点为在CT引导下对 肺叶各部位近胸膜的 结节均可定位 缺点是随着时间延长 亚甲蓝会扩大晕染范 围 或与肺表面碳墨沉 积点相混浊不易区分 而造成定位失败 中转 开胸 Our greatest weakness lies in giving up The most certain way to succeed is always to try just one more time 结节各种定位方法的优缺点 乳腺定位穿刺针CT引 导下肺穿刺定位 Our greatest weakness lies in giving up The most certain way to succeed is always to try just one more time 乳腺定位穿刺针CT引导下肺穿刺定位 乳腺定位穿刺针钩子直径展 开8mm 后接金属线 CT扫 描定位后套针穿刺进入 重复 CT扫描后显示针位于肺结节内 后立即释放钩子膨胀打开并位
