<link rel="stylesheet" href="https://studioyszimg.yxj.org.cn/css/video-js.min.css?v=1"><link rel="stylesheet" href="https://studioyszimg.yxj.org.cn/article/css/base.css?v=5"><link rel="stylesheet" href="https://studioyszimg.yxj.org.cn/article/css/index.css?v=35"><link rel="stylesheet" href="https://ysz-web.yxj.org.cn/live/dist/static/base/index.css?ysz_v=2.0"><script src="https://studioyszimg.yxj.org.cn/js/dsbridge.js?v=13" type="text/javascript"></script><script src="https://ysz-web.yxj.org.cn/dsBridge/main.js?v=26" type="text/javascript"></script><script src="https://ysz-web.yxj.org.cn/live/dist/static/base/fun.js?ysz_v=3" type="text/javascript"></script><script src="https://ysz-web.yxj.org.cn/live/dist/static/js/nativeToWeb.js?v=1" type="text/javascript"></script><div id="ysz-header" style="margin:0;overflow:hidden;"><h1 style="font-size:24px;line-height:1.8;color:#333333;word-wrap:break-word;">肺结节混合磨玻璃影,到底是肿瘤还是炎症?</h1><h2 style="font-size:16px;color:#999999;word-wrap:break-word;"><em style="font-style:normal;margin-right:10px;color:#7f7f7f;display:inline-block;">2021-04-07</em><em style="font-style:normal;margin-right:10px;color:#7f7f7f;display:inline-block;">小界</em><em style="font-style:normal;margin-right:10px;color:#7f7f7f;display:inline-block;">原创:医学界精品课</em></h2></div><p class="brief">最难懂的浸润性腺癌混合磨玻璃结节,给你讲明白!</p><div class="rich_media_content " id="js_content" style="margin: 0px; padding: 0px; overflow: hidden; overflow-wrap: break-word; hyphens: auto; text-align: justify; position: relative; z-index: 0; font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; letter-spacing: 0.544px; white-space: normal; background-color: rgb(255, 255, 255); visibility: visible;"><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; text-align: center; line-height: 1.75em;"><a target="_blank" href="https://yxj2.cn/CNnXE8" style="margin: 0px; padding: 0px; color: rgb(87, 107, 149); text-decoration-line: none; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); cursor: pointer; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></a><div class="appskip-wrap"><img class="appskip" data-appskip="yxjysz" data-appskipobj="{&quot;type&quot;:7,&quot;id&quot;:133,&quot;title&quot;:&quot;临床思维辨结节—肺恶性结节影像篇&quot;}" data-yxjysz="1" src="https://studioyszimg.yxj.org.cn/0A00007C0178AC0C87D37E0F3D9D1E3E.jpg"/><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);"><em class="appskip-icon"></em></span></div><a target="_blank" href="https://yxj2.cn/CNnXE8" style="margin: 0px; padding: 0px; color: rgb(87, 107, 149); text-decoration-line: none; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); cursor: pointer; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></a></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; line-height: 1.75em;"><br/></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; line-height: 1.75em;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">之前我们和大家分享了叶主任解读的</span><a target="_blank" href="http://mp.weixin.qq.com/s?__biz=MzU4NjYzNzg4Mg==&mid=2247487544&idx=2&sn=9ff3a8b617bf35a0a9c8d6a1f8b2f70f&chksm=fdf9676dca8eee7bcc844fc154b4630c418d5f890c43da5e6dccd53f386c505e8129dbd4c80e&scene=21#wechat_redirect" style="margin: 0px; padding: 0px; text-decoration: underline; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); cursor: pointer; max-width: 100%; font-size: 16px; line-height: 28px; color: rgb(0, 0, 0); box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">微浸润性腺癌</span></a><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">,今天就加大点难度,咱们来听听叶主任是怎么解读浸润性腺癌混合磨玻璃结节的!</span></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; line-height: 1.75em;"><br/></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; text-align: center; line-height: 1.75em;"><img class="rich_pages" src="https://studioyszimg.yxj.org.cn/0A00007C0178AC0C89BD360E5E1EF6DA.jpg" alt="图片" style="margin: 0px; padding: 0px; box-sizing: border-box ; overflow-wrap: break-word ; width: 677px ; visibility: visible ;"/></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; text-align: center; line-height: 1.75em;"><span style="line-height: 28px; color: rgb(0, 0, 0); font-size: 14px;">图1:叶建明主任在精品课开讲</span></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; line-height: 1.75em;"><br/></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; line-height: 1.75em;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">惯例,先从一个病例出发。患者主诉为“检查发现右肺上叶结节 3 月余”,5 天前在门诊查胸部 CT 的结果是“右肺上叶病灶,首先考虑纤维增殖钙化灶。建议三个月后复查。”</span></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; line-height: 1.75em;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">&nbsp;</span></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; line-height: 1.75em;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">紧接着,叶主任就带着我们一块解读了该患者的胸部 CT。从上往下滑动,记得不要错过影像图右边的分析哦~</span></section><section style="margin: 0px; padding: 0px; max-width: 100%; letter-spacing: 0.544px; font-size: 16px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="margin: 1em auto; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; border-width: initial; border-style: none; border-color: initial; color: rgb(0, 0, 0);"><section style="margin: 0px auto; padding: 1em; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; height: 10em; font-size: 1em; line-height: 1.5em; overflow: auto; background-image: initial; background-position: initial; background-size: initial; background-repeat: initial; background-attachment: initial; background-origin: initial; background-clip: initial;"><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; text-align: center; line-height: 1.75em;"><img class="rich_pages" src="https://studioyszimg.yxj.org.cn/0A00007C0178AC0C8BCD9CA83C659220.jpg" alt="图片" style="margin: 0px; padding: 0px; box-sizing: border-box ; overflow-wrap: break-word ; visibility: visible ; width: 498px ;"/></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; text-align: center; line-height: 1.75em;"><img class="rich_pages" src="https://studioyszimg.yxj.org.cn/0A00007C0178AC0C908862E67C2E38F0.jpg" alt="图片" style="margin: 0px; padding: 0px; box-sizing: border-box ; overflow-wrap: break-word ; width: 677px ; visibility: visible ;"/></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; text-align: center; line-height: 1.75em;"><img class="rich_pages" src="https://studioyszimg.yxj.org.cn/0A00007C0178AC0C92B422722997A5A5.jpg" alt="图片" style="margin: 0px; padding: 0px; box-sizing: border-box ; overflow-wrap: break-word ; width: 677px ; visibility: visible ;"/></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; text-align: center; line-height: 1.75em;"><img class="rich_pages" src="https://studioyszimg.yxj.org.cn/0A00007C0178AC0C974936ED00162E6B.jpg" alt="图片" style="margin: 0px; padding: 0px; box-sizing: border-box ; overflow-wrap: break-word ; width: 677px ; visibility: visible ;"/></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; text-align: center; line-height: 1.75em;"><img class="rich_pages" src="https://studioyszimg.yxj.org.cn/0A00007C0178AC0C9A09D2EA1D961B8D.jpg" alt="图片" style="margin: 0px; padding: 0px; box-sizing: border-box ; overflow-wrap: break-word ; width: 677px ; visibility: visible ;"/></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; text-align: center; line-height: 1.75em;"><img class="rich_pages" src="https://studioyszimg.yxj.org.cn/0A00007C0178AC0C9C84266D386C2D3D.jpg" alt="图片" style="margin: 0px; padding: 0px; box-sizing: border-box ; overflow-wrap: break-word ; width: 677px ; visibility: visible ;"/></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; text-align: center; line-height: 1.75em;"><img class="rich_pages" src="https://studioyszimg.yxj.org.cn/0A00007C0178AC0C9EE0C7C9173D20CE.jpg" alt="图片" style="margin: 0px; padding: 0px; box-sizing: border-box ; overflow-wrap: break-word ; width: 677px ; visibility: visible ;"/></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; text-align: center; line-height: 1.75em;"><img class="rich_pages" src="https://studioyszimg.yxj.org.cn/0A00007C0178AC0CA0C5325C06693EB7.jpg" alt="图片" style="margin: 0px; padding: 0px; box-sizing: border-box ; overflow-wrap: break-word ; width: 677px ; visibility: visible ;"/></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; text-align: center; line-height: 1.75em;"><img class="rich_pages" src="https://studioyszimg.yxj.org.cn/0A00007C0178AC0CA5326D5812EF27DC.jpg" alt="图片" style="margin: 0px; padding: 0px; box-sizing: border-box ; overflow-wrap: break-word ; width: 677px ; visibility: visible ;"/></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; text-align: center; line-height: 1.75em;"><br/></section></section></section></section></section></section></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; letter-spacing: 0.544px; text-align: center; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span style="line-height: 28px; color: rgb(0, 0, 0); font-size: 14px;">图2~10:该患者各个角度的影像图像</span></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; letter-spacing: 0.544px; font-size: 16px; text-align: center; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span style="line-height: 28px; color: rgb(0, 0, 0); font-size: 14px;">(▲▼上下滑动查看全部图片)</span></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; letter-spacing: 0.544px; font-size: 16px; text-align: center; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br/></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; line-height: 1.75em;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">根据解读影像学图像,叶主任认为该患者右肺的结节为混合磨玻璃结节,实性成分占比高,边缘有磨玻璃成份,且有明显恶性特征(如:分叶征、血管征、细毛刺征、胸膜凹陷征、且病灶内部密度杂乱不均)。</span></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; line-height: 1.75em;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">&nbsp;</span></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; line-height: 1.75em;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">虽然影像科没有明确报肺癌,但是叶主任认为这是非常典型的以混合磨玻璃为表现的浸润性腺癌。</span></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; line-height: 1.75em;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">&nbsp;</span></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; line-height: 1.75em;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">胸腔镜下右肺上叶切除加淋巴结清扫术后,也发现这个是灰白色、具有牵拉性的实性结节。进一步对该灰白色结节行病理分析,发现确实是浸润性腺癌。</span></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; line-height: 1.75em;"><br/></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; text-align: center; line-height: 1.75em;"><img class="rich_pages" src="https://studioyszimg.yxj.org.cn/0A00007C0178AC0CAA739EA62DD48664.jpg" alt="图片" style="margin: 0px; padding: 0px; box-sizing: border-box ; overflow-wrap: break-word ; width: 677px ; visibility: visible ;"/></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; text-align: center; line-height: 1.75em;"><span style="line-height: 28px; color: rgb(0, 0, 0); font-size: 14px;">图11:该患者右肺结节切除后的实物图</span></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; line-height: 1.75em;"><br/></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; line-height: 1.75em;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">回过头来,结合这位患者的影像学表现和自身的临床经验,叶主任也为我们总结了浸润性腺癌混合磨玻璃结节的影像学特征。</span></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; line-height: 1.75em;"><br/></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; text-align: center; line-height: 1.75em;"><img class="rich_pages" src="https://studioyszimg.yxj.org.cn/0A00007C0178AC0CACAF2E3178744A12.jpg" alt="图片" style="margin: 0px; padding: 0px; box-sizing: border-box ; overflow-wrap: break-word ; width: 677px ; visibility: visible ;"/></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; text-align: center; line-height: 1.75em;"><span style="line-height: 28px; color: rgb(0, 0, 0); font-size: 14px;">图12:叶主任总结的浸润性腺癌混合磨玻璃结节的影像学特征</span></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; line-height: 1.75em;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">&nbsp;</span></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; line-height: 1.75em;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">叶主任强调,混合磨玻璃结节有可能会转移,也可能存在高危因素(如脉管癌栓、微乳头成分、侵犯胸膜等)。实性成分占比越高,密度越大,危险性越高。如果混合磨玻璃结节以磨玻璃成分为主,伴少许实性成分,则多数情况仍为不容易存在转移。</span></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; line-height: 1.75em;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">&nbsp;</span></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; line-height: 1.75em;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">但是,因为混合磨玻璃结节并不总是肺癌,炎症吸收期、某些感染、甚至肺泡出血等也可能表现为类似混合磨玻璃,特别是较小的病灶时,需要我们适当的试验性抗炎治疗与观察随访,以确定其会不会吸收好转。</span></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; line-height: 1.75em;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">&nbsp;</span></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; line-height: 1.75em;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">如果混合磨玻璃结节考虑是浸润性腺癌,那肯定有手术指征&nbsp;,但是,选择哪种手术方式也是门学问。</span></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; line-height: 1.75em;"><br/></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; text-align: center; line-height: 1.75em;"><div class="appskip-wrap"><img class="appskip" data-appskip="yxjysz" data-appskipobj="{&quot;type&quot;:7,&quot;id&quot;:133,&quot;title&quot;:&quot;临床思维辨结节—肺恶性结节影像篇&quot;}" data-yxjysz="1" src="https://studioyszimg.yxj.org.cn/0A00007C0178AC0CAEA83C1B2FC3BF26.jpg"/><em class="appskip-icon"></em></div></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; text-align: center; line-height: 1.75em;"><span style="line-height: 28px; color: rgb(0, 0, 0); font-size: 14px;">图13:浸润性腺癌混合磨玻璃结节的手术方式:楔切、段切、叶切(从左到右)</span></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; line-height: 1.75em;"><br/></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; line-height: 1.75em;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">肺癌治疗指南上表明,早期肺癌是要手术的,而且标准术式是解剖性肺叶切除加淋巴结清扫。</span></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; line-height: 1.75em;"><br/></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; line-height: 1.75em;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">只要是浸润性腺癌,行肺叶切除加清扫是符合规范的。若<2cm 的病灶,指南是说磨玻璃成份大于 50% 可亚肺叶切除,但仍显过于笼统,可操作性不够。</span></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; line-height: 1.75em;"><br/></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; line-height: 1.75em;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">但是,如果病灶<2cm,伴有微乳头成分或侵犯胸膜等高危因素时难道也亚肺叶切除?或者如果病灶>2cm,若 90% 以上为纯磨玻璃,只有少许实性成分,也一定要肺叶切除?</span></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; line-height: 1.75em;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">&nbsp;</span></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; line-height: 1.75em;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">在这个问题上,叶主任提出了自己的看法——<strong style="margin: 0px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">混合磨玻璃结节病理是浸润性腺癌的,多趋于选择肺叶切除,但应该有选择的做部分亚肺叶切除手术。</strong></span></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; line-height: 1.75em;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);"><strong style="margin: 0px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br/></strong></span></section><ul class=" list-paddingleft-2"><li><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; line-height: 1.75em;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">如果病理确定是浸润性腺癌,又是混合磨玻璃结节,不管亚型如何,都可行肺叶切除。</span></section></li><li><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; line-height: 1.75em;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">随着多原发腺癌的比例升高,特别是年纪较轻的病人,仍要考虑到日后再新发病灶的可能性,为以后的再治疗留些余地。对有些靠肺外周的部位,亚型属于高分化的、转移风险不大的,不管大小是否以 2cm 为界,仍要考虑选用楔切与肺段切除的手术方式。</span></section></li><li><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; line-height: 1.75em;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">不存在淋巴结转移时,淋巴结的清扫可能只是增加了创伤和术后并发症以及咳嗽等不适,只是不清扫没有依据而已,此时采样是否可能?</span></section></li></ul><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; line-height: 1.75em;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">&nbsp;</span></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; line-height: 1.75em;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">叶主任根据自身临床经验,总结出针对混合磨玻璃结节手术方式的评分表。</span></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; line-height: 1.75em;"><br/></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; line-height: 1.75em;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">由于没有足够的临床样本估测该评分表的质量,叶主任强调这只是给各位在针对患者个体化选择手术方式时的一个方向,也希望感兴趣的同行一起来研究该方式和有效性和可行性。</span></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; line-height: 1.75em;"><br/></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; text-align: center; line-height: 1.75em;"><img class="rich_pages" src="https://studioyszimg.yxj.org.cn/0A00007C0178AC0CB0BE32C114E12E7B.jpg" alt="图片" style="margin: 0px; padding: 0px; box-sizing: border-box ; overflow-wrap: break-word ; width: 677px ; visibility: visible ;"/></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; text-align: center; line-height: 1.75em;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">图14:叶主任个人混合磨玻璃结节手术方式的评分值</span></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; text-align: left; line-height: 1.75em;"><br/></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; line-height: 1.75em;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">同时,叶主任强调,<strong style="margin: 0px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">如果选择亚肺叶切除,最好同时行淋巴结采样,并与患方做好细致的沟通。</strong></span></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; line-height: 1.75em;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">&nbsp;</span></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; line-height: 1.75em;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">叶主任也为大家举了三个例子,论证选择不同术式的原因。</span></section><section style="margin: 0px; padding: 0px; max-width: 100%; letter-spacing: 0.544px; font-size: 16px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="margin: 1em auto; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; border-width: initial; border-style: none; border-color: initial; color: rgb(0, 0, 0);"><section style="margin: 0px auto; padding: 1em; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; height: 10em; font-size: 1em; line-height: 1.5em; overflow: auto; background-image: initial; background-position: initial; background-size: initial; background-repeat: initial; background-attachment: initial; background-origin: initial; background-clip: initial;"><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; text-align: center; line-height: 1.75em;"><img class="rich_pages" src="https://studioyszimg.yxj.org.cn/0A00007C0178AC0CB641D8DC6FDC1CA7.jpg" alt="图片" style="margin: 0px; padding: 0px; box-sizing: border-box ; overflow-wrap: break-word ; visibility: visible ; width: 498px ;"/></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; text-align: center; line-height: 1.75em;"><img class="rich_pages" src="https://studioyszimg.yxj.org.cn/0A00007C0178AC0CB8BCD6D74237639F.jpg" alt="图片" style="margin: 0px; padding: 0px; box-sizing: border-box ; overflow-wrap: break-word ; width: 677px ; visibility: visible ;"/></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; text-align: center; line-height: 1.75em;"><img class="rich_pages" src="https://studioyszimg.yxj.org.cn/0A00007C0178AC0CBA58900E35B8A2AD.jpg" alt="图片" style="margin: 0px; padding: 0px; box-sizing: border-box ; overflow-wrap: break-word ; width: 677px ; visibility: visible ;"/></section></section></section></section></section></section></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; letter-spacing: 0.544px; text-align: center; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span style="line-height: 28px; color: rgb(0, 0, 0); font-size: 14px;">图15~17:论证选择不同术式的三个例子</span></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; letter-spacing: 0.544px; font-size: 16px; text-align: center; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span style="line-height: 28px; color: rgb(0, 0, 0); font-size: 14px;">(▲▼上下滑动查看全部图片)</span></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; line-height: 1.75em;"><br/></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; line-height: 1.75em;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">针对浸润性腺癌合并混合磨玻璃结节的术式选择,叶主任总结到:</span></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; line-height: 1.75em;"><br/></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; text-align: center; line-height: 1.75em;"><img class="rich_pages" src="https://studioyszimg.yxj.org.cn/0A00007C0178AC0CBCEE09CD532AFA00.jpg" alt="图片" style="margin: 0px; padding: 0px; box-sizing: border-box ; overflow-wrap: break-word ; width: 677px ; visibility: visible ;"/></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; text-align: center; line-height: 1.75em;"><span style="line-height: 28px; color: rgb(0, 0, 0); font-size: 14px;">图18:叶主任对浸润性腺癌合并混合磨玻璃结节的术式选择的总结</span></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; line-height: 1.75em;"><br/></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; line-height: 1.75em;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">最后,对浸润性腺癌合并混合磨玻璃结节的情况,叶主任总结如下:</span></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; line-height: 1.75em;"><br/></section><section style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; text-align: center; line-height: 1.75em;"><img class="rich_pages" src="https://studioyszimg.yxj.org.cn/0A00007C0178AC0CC007C9886C759938.jpg" alt="图片" style="margin: 0px; padding: 0px; box-sizing: border-box ; overflow-wrap: break-word ; width: 677px ; visibility: visible ;"/></section><p style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; text-align: center; line-height: 1.75em;"><span style="line-height: 28px; color: rgb(0, 0, 0); font-size: 14px;">图19:叶主任对浸润性腺癌合并混合磨玻璃结节的总结</span></p><p style="margin: 0px 16px; padding: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br/></p><p style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; line-height: 1.75em;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">一文下来,相信各位读者已经基本掌握浸润性腺癌合并混合磨玻璃结节的诊断和治疗了。想直击叶主任讲课现场的赶快搜索<strong>《临床思维辨结节——肺恶性结节影像篇》</strong>看精品课哦!更有叶主任的拓展视野内容增长见识哦!</span></p><p style="margin: 0px 16px; padding: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important; text-align: center;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);"><span class="ysz-ueditor-title-one" style="font-size: 18px; line-height: 28px; font-weight: bold; color: rgb(215, 0, 15); text-align: left;">↓↓点击下方图片立即前往观看↓↓</span></span><br/></p><p style="margin: 0px 16px; padding: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important; text-align: center;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);"></span></p><div class="appskip-wrap"><img class="appskip" data-appskip="yxjysz" data-appskipobj="{&quot;type&quot;:7,&quot;id&quot;:133,&quot;title&quot;:&quot;临床思维辨结节—肺恶性结节影像篇&quot;}" data-yxjysz="1" src="https://studioyszimg.yxj.org.cn/83gwbieeuj4.png"/><em class="appskip-icon"></em></div><p style="margin: 0px 16px; padding: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important; text-align: center;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);"></span><br/></p><p><br/></p><p style="margin: 0px 16px; padding: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; line-height: 1.75em;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);"></span><br/></p></div><p><br/></p>

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