肺结节空间位置对肺亚段解剖单元亚肺叶切除术范围及疗效的影响

doi:10.19983/j.issn.2096-8493.20260038

摘要/Abstract

摘要：

目的: 探讨肺结节(pulmonary nodule,PN)空间位置对肺亚段解剖单元亚肺叶切除术(sublobar resection,SR)范围及疗效的影响。方法: 以2022年2月至2025年2月太仓市第一人民医院胸外科114例接受SR治疗且符合标准的PN患者为研究对象。基于肺亚段解剖单元,依据手术切除范围不同,将患者分为试验1组(单一肺亚段切除,34例)、试验2组(联合肺亚段切除,39例)和对照组(单一肺段切除,41例)。收集三组患者的基线资料与PN影像资料,统计分析各指标对SR范围的影响。另统计试验1组与试验2组患者PN复发与转移情况,观察不同PN空间位置患者的手术疗效。结果: logistic回归分析显示,对照单一肺段切除,PN最大径、PN横向位置、PN深度位置是SR采用单一肺亚段切除的影响因素(OR=2.754,95%CI:1.488~5.097;OR=3.063,95%CI:1.290~7.273;OR=2.681,95%CI:1.576~4.561),PN横向位置是SR采用肺联合肺亚段切除的影响因素(OR=2.833,95%CI:1.604~5.004)。不同横向位置与深度位置PN采用不同SR后在随访时间内均未发生复发和转移。结论: PN空间位置是确定以肺亚段为解剖单元的SR范围的重要因素,PN空间位置对SR疗效无明显影响。

关键词: 结节, 肺, 空间位置, 肺切除术, 治疗结果

Abstract:

Objective: To investigate the impact of the spatial location of pulmonary nodules (PN) on the extent and efficacy of sublobar resection (SR) based on pulmonary subsegmental anatomical units. Methods: A total of 114 eligible PN patients who received SR were enrolled from the Department of Thoracic Surgery, Taicang First People’s Hospital, between February 2022 and February 2025. Based on the pulmonary subsegmental anatomical units, patients were allocated into three groups stratified by resection scope:Group 1 (single pulmonary subsegmental resection, n=34), Group 2 (combined pulmonary subsegmental resection, n=39), and the Control Group (single pulmonary segmental resection, n=41). Baseline data and PN imaging data of the three groups were collected and statistical analyses were performed to assess the impact of various indicators on the resection scope of SR. In addition, PN recurrence and metastasis in Group 1 and Group 2 were analyzed to compare surgical efficacy among patients with different PN spatial locations. Results: Logistic regression analysis revealed that compared with single pulmonary segmental resection, maximum diameter, lateral location and depth location of PN were influencing factors for single pulmonary subsegmental resection (OR=2.754, 95%CI:1.488-5.097; OR=3.063, 95%CI:1.290-7.273; OR=2.681, 95%CI:1.576-4.561) and the lateral location of PN was an influencing factor for combined pulmonary subsegmental resection (OR=2.833, 95%CI:1.604-5.004). No recurrence or metastasis was observed during follow-up in patients with PN at different lateral and depth location after undergoing different SR procedures. Conclusion: The spatial location of PN is an important factor in determining the scope of SR based on pulmonary subsegmental anatomical units, whereas it has no significant influence on the efficacy of SR.

Key words: Nodule, pulmonary, Spatial location, Sublobar resection, Treatment outcome

中图分类号:

R734.2
R563

邵宇峰, 朱庆丰, 郑年鹏, 陈荣进, 舒健. 肺结节空间位置对肺亚段解剖单元亚肺叶切除术范围及疗效的影响[J]. 结核与肺部疾病杂志, 2026, 7(4): 443-447. doi: 10.19983/j.issn.2096-8493.20260038

Shao Yufeng, Zhu Qingfeng, Zheng Nianpeng, Chen Rongjin, Shu Jian. Influence of spatial location of pulmonary nodules on the scope and efficacy of sublobar resection based on pulmonary subsegmental anatomical units[J]. Journal of Tuberculosis and Lung Disease, 2026, 7(4): 443-447. doi: 10.19983/j.issn.2096-8493.20260038

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参考文献 11

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指标	试验1组(34例)	试验2组(39例)	对照组(41例)	χ²值	P值
性别[例(构成比,%)]				0.193	0.908
男性	18(52.9)	20(51.3)	23(56.1)
女性	16(47.1)	19(48.7)	18(43.9)
年龄组[例(构成比,%)]				0.233	0.890
≥60岁	18(52.9)	21(53.8)	20(48.8)
<60岁	16(47.1)	18(46.2)	21(51.2)
合并症[例(发生率,%)]
吸烟	3(8.8)	6(15.4)	7(17.1)	1.138	0.566
高血压	7(20.6)	10(25.6)	10(24.4)	0.274	0.872
糖尿病	3(8.8)	4(10.3)	5(12.2)	0.229	0.892
结节性质[例(发生率,%)]				0.160	0.923
纯磨玻璃	21(61.8)	22(56.4)	24(58.5)
混合磨玻璃	13(38.2)	17(43.6)	17(41.5)
PN最大径[例(构成比,%)]				13.524	0.001
<1.5cm	34(100.0)	33(84.6)	28(68.3)
≥1.5cm	0(0.0)	6(15.4)	13(31.7)
PN横向位置[例(构成比,%)]				89.926	<0.001
段内	34(100.0)	39(100.0)	6(14.6)
段间	0(0.0)	0(0.0)	35(85.4)
PN深度位置[例(构成比,%)]				7.707	0.021
外带	33(97.1)	32(82.1)	30(73.2)
中带	1(2.9)	7(17.9)	11(26.8)
内带	0(0.0)	0(0.0)	0(0.0)

因素	β值	s${}_{\overline{\mathit{x}}}$值	Wald χ²值	P值	OR值	95%CI值
试验1组和对照组
PN最大径	1.013	0.314	10.403	0.001	2.754	1.488~5.097
PN横向位置	1.119	0.441	6.437	0.011	3.063	1.290~7.273
PN深度位置	0.986	0.271	13.236	<0.001	2.681	1.576~4.561
试验2组和对照组
PN横向位置	1.041	0.290	12.874	<0.001	2.833	1.604~5.004

PN横向位置	SR方式	例数	随访时间 (月,$\overline{\mathit{x}}$±s)	复发[例 (复发率,%)]	转移[例 (转移率,%)]
段内	单一肺亚段切除	34	27.42±8.16	0(0.0)	0(0.0)
	联合肺亚段切除	39	29.05±7.83	0(0.0)	0(0.0)
段间	单一肺亚段切除	0	-	-	-
	联合肺亚段切除	0	-	-	-

PN深度位置	SR方式	例数	随访时间 (月,$\overline{\mathit{x}}$±s)	复发[例 (复发率,%)]	转移[例 (转移率,%)]
外带	单一肺亚段切除	33	28.57±7.94	0(0.0)	0(0.0)
	联合肺亚段切除	32	29.36±7.90	0(0.0)	0(0.0)
中带	单一肺亚段切除	1	22.00	0(0.0)	0(0.0)
	联合肺亚段切除	7	24.35±4.61	0(0.0)	0(0.0)
内带	单一肺亚段切除	0	-	-	-
	联合肺亚段切除	0	-	-	-

组别	例数	第一秒内呼气容积		用力肺活量
组别	例数	术前	术后1个月	术前	术后1个月
试验1组	34	0.56±0.10	0.55±0.06	0.68±0.09	0.64±0.08
试验2组	39	0.54±0.11	0.52±0.05	0.67±0.10	0.62±0.06
对照组	41	0.53±0.08	0.49±0.06	0.65±0.09	0.59±0.07
χ²值		1.474	16.701	1.603	7.651
P值		0.232	<0.001	0.204	<0.001