肺结节规范化诊治专家共识

doi:10.19983/j.issn.2096-8493.2024084

摘要/Abstract

摘要：

肺结节筛查计划推广及低剂量胸部CT日益普及,让更多肺结节患者得到早期诊断。但如何精准识别高危肺结节,让患者得到准确诊断和规范化诊疗,是目前肺结节诊疗的热点和难点。2015年首部“肺结节诊治专家共识”发表后,各个地区结合当地实情相继完善了肺结节诊治与管理策略,参考国内外文献成果及现有的肺结节诊疗专家共识,结合筛查肺结节的临床诊疗经验,经过呼吸、感染、影像、病理等领域专家的多轮会议研讨,最终制定了这部肺结节诊治专家共识。通过阐述肺结节的诊治要点、治疗方法选择,旨在让呼吸学科及相关学科医师对肺结节规范诊疗有一个全面认识,也为各级医院开展肺结节规范诊治工作提供参考依据。

关键词: 肺结节, 诊断, 治疗, 专家共识

Abstract:

With the promotion of pulmonary nodule screening program and the increasing popularity of low-dose chest CT, more patients with pulmonary nodules to get a preliminary diagnosis. However, the hot and difficult point of pulmonary nodule diagnosis and treatment is that how to accurately recognize high-risk pulmonary nodules, and enable patients get accurate and standardized diagnosis and treatment. After the publication of the first “Expert consensus on the diagnosis and treatment of pulmonary nodules” in 2015, various regions have successively improved the diagnosis and management strategies of pulmonary nodules based on local conditions. After several rounds of meetings and discussions held by experts in respiratory, infection, imaging, pathology and other fields, this expert consensus on the diagnosis and treatment of pulmonary nodules eventually has been formulated by referring to domestic and foreign literature results, expert consensus on diagnosis and treatment of pulmonary nodules as well as the clinical diagnosis and treatment experience of screening pulmonary nodules. By elaborating the diagnosis and treatment of pulmonary nodules, physicians of respiratory and related disciplines have a comprehensive understanding of the standardized diagnosis and treatment of pulmonary nodules, and it also provides reference for hospitals at all levels to carry out the plan of pulmonary nodules.

Key words: Pulmonary nodules, Diagnosis, Treatment, Expert consensus

中图分类号:

云南省传染性疾病临床医学中心, 云南省医院协会呼吸内科专业委员会, 昆明市医学会肺结节早诊早治专业委员会. 肺结节规范化诊治专家共识[J]. 结核与肺部疾病杂志, 2024, 5(5): 388-397. doi: 10.19983/j.issn.2096-8493.2024084

Yunnan Provincial Clinical Medical Center for Infectious Disease, Professional Committee of Respiratory Medicine of Yunnan Hospital Association, Professional Committee of Early Diagnosis and Treatment of Pulmonary Nodules of Kunming Medical Association. Expert consensus on standardized diagnosis and treatment of pulmonary nodules[J]. Journal of Tuberculosis and Lung Disease, 2024, 5(5): 388-397. doi: 10.19983/j.issn.2096-8493.2024084

图/表 2

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项目	良性结节	恶性结节
形态特征	圆形、类圆形、三角形	圆形、类圆形
边缘特征	光滑、平整,长毛刺	分叶、短毛刺、胸膜牵拉、胸膜附着、胸膜凹陷、胸膜尾征
交界面特征	清楚、整齐,甚至光整	清楚但毛糙
内部特征	呈脂肪密度、钙化、低密度液化	血管征(扭曲/扩张/僵硬)、空泡征及囊腔型
邻近结构	周围血管分布走向正常或绕行	胸膜凹陷征、血管集束征
血供(强化程度)	无强化或轻度强化,硬化性肺泡细胞瘤、活动性炎性结节及血管性病变可呈明显强化,强化峰值多出现在动脉期	中度以上均匀或不均匀强化,强化峰值多出现在延迟期