<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;">病例分享:两肺结节随访2年,主病灶三易其主,这是怎么了?</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;">2021-09-08</em><em style="font-style:normal;margin-right:10px;color:#7f7f7f;display:inline-block;">叶建明</em><em style="font-style:normal;margin-right:10px;color:#7f7f7f;display:inline-block;">原创:叶建明说结节</em></h2></div><p style="text-align: justify;"><span style="color: rgb(0, 0, 0); font-size: 16px;">前言:今天分享一个非常特殊,也非常有警示意义的病例,其随访情况与最终结果一变再变、一波三折。也是从另一个角度来说明肺结节的复杂性、可变性与我们应该保持持续警惕的重要性!</span><br/></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">患者某A,是我们医院同事的的母亲,今年60岁。她于2019年时在外院查出右肺下叶病灶,因为外院的影像资料没有拿到,所以最早的是2019年11月份在我们医院复查的。</span></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-title-one" style="font-size: 16px; line-height: 28px; font-weight: bold; color: rgb(215, 0, 15); text-align: left;">第一场:2019年11月:主病灶为右下叶结节(下称病灶A)</span></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">因为外院说要担心右下的混合磨玻璃病灶,所以当时复查时做了平扫加右下叶靶扫描,我们先来看当时的影像资料:</span></p><p><br/></p><p style="padding: 0px; outline: 0px; max-width: 100%; min-height: 1em; 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: 0.621714px; text-align: center; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><img class="rich_pages wxw-img" src="https://studioyszimg.yxj.org.cn/0A00007C017BBEECFD92F4A9249A95A3.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; box-sizing: border-box ; overflow-wrap: break-word ; width: 512px ; visibility: visible ;"/></p><p style="padding: 0px; outline: 0px; max-width: 100%; min-height: 1em; 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: 0.621714px; text-align: center; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><img class="rich_pages wxw-img" src="https://studioyszimg.yxj.org.cn/0A00007C017BBEECFEF8FEC811046644.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; box-sizing: border-box ; overflow-wrap: break-word ; width: 512px ; visibility: visible ;"/></p><p style="padding: 0px; outline: 0px; max-width: 100%; min-height: 1em; 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: 0.621714px; text-align: center; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><img class="rich_pages wxw-img" src="https://studioyszimg.yxj.org.cn/0A00007C017BBEED00FB5A704F8F2E99.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; box-sizing: border-box ; overflow-wrap: break-word ; width: 512px ; visibility: visible ;"/></p><p style="padding: 0px; outline: 0px; max-width: 100%; min-height: 1em; 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: 0.621714px; text-align: center; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><img class="rich_pages wxw-img" src="https://studioyszimg.yxj.org.cn/0A00007C017BBEED0260711330FB1CCF.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; box-sizing: border-box ; overflow-wrap: break-word ; width: 512px ; visibility: visible ;"/></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">可见是右下叶病灶,混合磨玻璃样,但中间实性部分密度过高,周围磨玻璃部分密度过低,病灶呈长条状,邻近胸膜有增厚,粘连,有的层面毛刺过长。应该考虑是慢性炎性病灶可能性大。下面是当时的影像报告:</span></p><p><br/></p><p style="text-align: center;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);"><img class="rich_pages wxw-img" src="https://studioyszimg.yxj.org.cn/0A00007C017BBEED0398C4B13E172E4F.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; 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: 0.621714px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box ; overflow-wrap: break-word ; width: 677px ; visibility: visible ;"/></span></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">报告也是说考虑纤维灶可能性大。但同事叫我看片时,阅片后发现她的右上叶与左上叶也有异常结节影,来看下面的影像:</span></p><p><br/></p><p style="text-align: center;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);"><img class="rich_pages wxw-img" src="https://studioyszimg.yxj.org.cn/0A00007C017BBEED04ECED8D611C9D1C.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; 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: 0.621714px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box ; overflow-wrap: break-word ; width: 512px ; visibility: visible ;"/></span></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">右上叶前段病灶,实性微小结节,邻近血管略增粗,有间隙,考虑局部慢性炎可能性大,建议随访。</span></p><p><br/></p><p style="text-align: center;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);"><img class="rich_pages wxw-img" src="https://studioyszimg.yxj.org.cn/0A00007C017BBEED06A503A47D207DF1.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; 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: 0.621714px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box ; overflow-wrap: break-word ; width: 512px ; visibility: visible ;"/></span></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">上图示左上叶前段磨玻璃结节,部分边缘显模糊,但邻近血管似乎与之关系不清不楚,而且靠纵隔侧的边缘过于清晰,需要警惕。所以当时我与同事讲,右下的病灶不大要紧,良性可能性大,倒是左上这个病灶要担心,但磨玻璃结节危险性小,仍可随访,建议半年后复查平扫加左上叶靶扫描,右上叶也可靶扫描下。</span></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-title-one" style="font-size: 16px; line-height: 28px; font-weight: bold; color: rgb(215, 0, 15); text-align: left;">第二场:2020年6月:主病灶考虑为左上叶前段病灶(下称病灶B)</span></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">平时也没有症状,复查时略迟了个把月,因为几个病灶都没有明显变化,B病灶虽考虑恶性可能性大,但因与七个月前无明显变化,仍嘱其复查,下面只选取的是2020年6月检查与2019年11月时的对比情况:</span></p><p><br/></p><p style="padding: 0px; outline: 0px; max-width: 100%; min-height: 1em; 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: 0.621714px; text-align: center; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><img class="rich_pages wxw-img" src="https://studioyszimg.yxj.org.cn/0A00007C017BBEED07DEBC56673941A8.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; box-sizing: border-box ; overflow-wrap: break-word ; width: 677px ; visibility: visible ;"/></p><p style="padding: 0px; outline: 0px; max-width: 100%; min-height: 1em; 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: 0.621714px; text-align: center; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><img class="rich_pages wxw-img" src="https://studioyszimg.yxj.org.cn/0A00007C017BBEED0952375E46B99589.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; box-sizing: border-box ; overflow-wrap: break-word ; width: 677px ; visibility: visible ;"/></p><p style="padding: 0px; outline: 0px; max-width: 100%; min-height: 1em; 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: 0.621714px; text-align: center; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><img class="rich_pages wxw-img" src="https://studioyszimg.yxj.org.cn/0A00007C017BBEED0B3999F85CAC7D6B.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; box-sizing: border-box ; overflow-wrap: break-word ; width: 677px ; visibility: visible ;"/></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">可见几乎没有明显变化,右下病灶似乎还略有收缩了一点,更像疤痕组织了些。下面是当时的影像报告:</span></p><p><br/></p><p style="text-align: center;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);"><img class="rich_pages wxw-img" src="https://studioyszimg.yxj.org.cn/0A00007C017BBEED0D30A7E7695092F9.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; 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: 0.621714px; text-align: center; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box ; overflow-wrap: break-word ; width: 677px ; visibility: visible ;"/></span></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">这次报告上也提到左上叶的结节影以及右上叶的小结节,但与前相仿。所以嘱继续随访复查,建议半年到一年均可。但大概因为没有什么不舒服,且半年没什么变化,所以今年的复查又迟了一点,到了2021年9月份。</span></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-title-one" style="font-size: 16px; line-height: 28px; font-weight: bold; color: rgb(215, 0, 15); text-align: left;">第三场:2021年9月:主病灶为右上叶前段结节(下称病灶C)</span></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">这次检查因为右下之前没什么变化,而且考虑纤维灶或慢性炎,所以没有申请右下叶靶扫描,而是平扫加右上叶与左上叶靶扫描。结果发现病灶有了变化!影像报告示:</span></p><p><br/></p><p style="text-align: center;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);"><img class="rich_pages wxw-img" src="https://studioyszimg.yxj.org.cn/0A00007C017BBEED0F0B815A41A89428.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; 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: 0.621714px; text-align: center; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box ; overflow-wrap: break-word ; width: 677px ; visibility: visible ;"/></span></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">最关键的是右肺上叶结节,对照2020.6.7增大!右上还另有磨玻璃结节,左上也有磨玻璃结节(病灶B),右下病灶(病灶A)与前相仿。我们先来看下右下病灶:</span></p><p><br/></p><p style="padding: 0px; outline: 0px; max-width: 100%; min-height: 1em; 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: 0.621714px; text-align: center; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><img class="rich_pages wxw-img" src="https://studioyszimg.yxj.org.cn/0A00007C017BBEED10AA03A74789E5A6.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; box-sizing: border-box ; overflow-wrap: break-word ; width: 512px ; visibility: visible ;"/></p><p style="padding: 0px; outline: 0px; max-width: 100%; min-height: 1em; 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: 0.621714px; text-align: center; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><img class="rich_pages wxw-img" src="https://studioyszimg.yxj.org.cn/0A00007C017BBEED12139767166392F8.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; box-sizing: border-box ; overflow-wrap: break-word ; width: 512px ; visibility: visible ;"/></p><p style="padding: 0px; outline: 0px; max-width: 100%; min-height: 1em; 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: 0.621714px; text-align: center; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><img class="rich_pages wxw-img" src="https://studioyszimg.yxj.org.cn/0A00007C017BBEED1391B21D2819F2FC.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; box-sizing: border-box ; overflow-wrap: break-word ; width: 512px ; visibility: visible ;"/></p><p style="padding: 0px; outline: 0px; max-width: 100%; min-height: 1em; 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: 0.621714px; text-align: center; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><img class="rich_pages wxw-img" src="https://studioyszimg.yxj.org.cn/0A00007C017BBEED14C5AB093EE4A534.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; box-sizing: border-box ; overflow-wrap: break-word ; width: 512px ; visibility: visible ;"/></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">可见右下病灶A仍无明显变化,历经近2年没有变化,且影像也倾向良性,那么更加可以考虑良性了。暂不需要管它。再来看左上叶的病灶B,平扫与靶扫描是下面这样的:</span></p><p><br/></p><p style="padding: 0px; outline: 0px; max-width: 100%; min-height: 1em; 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: 0.621714px; text-align: center; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><img class="rich_pages wxw-img" src="https://studioyszimg.yxj.org.cn/0A00007C017BBEED1618CD392113C25E.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; box-sizing: border-box ; overflow-wrap: break-word ; width: 512px ; visibility: visible ;"/></p><p style="padding: 0px; outline: 0px; max-width: 100%; min-height: 1em; 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: 0.621714px; text-align: center; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><img class="rich_pages wxw-img" src="https://studioyszimg.yxj.org.cn/0A00007C017BBEED176BFB4A21B363FA.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; box-sizing: border-box ; overflow-wrap: break-word ; width: 512px ; visibility: visible ;"/></p><p style="padding: 0px; outline: 0px; max-width: 100%; min-height: 1em; 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: 0.621714px; text-align: center; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><img class="rich_pages wxw-img" src="https://studioyszimg.yxj.org.cn/0A00007C017BBEED18B4346C7266A676.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; box-sizing: border-box ; overflow-wrap: break-word ; width: 512px ; visibility: visible ;"/></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">平扫上变化不大,仍是磨玻璃结节,但一直没有吸收好转,显然是恶性的,需不需要马上处理另议,来看看下面靶扫描上显示的细节:</span></p><p><br/></p><p style="text-align: center;"><span style="line-height: 28px; font-size: 14px; color: rgb(136, 136, 136);"><img class="rich_pages wxw-img" src="https://studioyszimg.yxj.org.cn/0A00007C017BBEED1A4695F558BE1422.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; 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: 0.621714px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box ; overflow-wrap: break-word ; width: 677px ; visibility: visible ;"/></span></p><p style="text-align: center;"><span style="line-height: 28px; font-size: 14px; color: rgb(136, 136, 136);">病灶有明显的月芽铲征(砖色箭头),病灶轮廓清楚,边缘清晰(红色箭头)</span></p><p><br/></p><p style="text-align: center;"><span style="line-height: 28px; font-size: 14px; color: rgb(136, 136, 136);"><img class="rich_pages wxw-img" src="https://studioyszimg.yxj.org.cn/0A00007C017BE62AD0BA5F2F7182F9C7.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; 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: 0.621714px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box ; overflow-wrap: break-word ; width: 677px ; visibility: visible ;"/></span></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">上图示病灶有血管弯征(桔色箭头),我们见到血管靠近病灶处凹向病灶侧,说明病灶需要血供,想让血管靠过去,并生出小血管进入病灶去,也是恶性征象之一。</span></p><p><br/></p><p style="text-align: center;"><span style="line-height: 28px; font-size: 14px; color: rgb(136, 136, 136);"><img class="rich_pages wxw-img" src="https://studioyszimg.yxj.org.cn/0A00007C017BBEED1D1D2B1B203D5C73.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; 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: 0.621714px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box ; overflow-wrap: break-word ; width: 677px ; visibility: visible ;"/></span></p><p style="text-align: center;"><span style="line-height: 28px; font-size: 14px; color: rgb(136, 136, 136);">上图也示血管弯,且病灶密度显不均匀</span></p><p><br/></p><p style="padding: 0px; outline: 0px; max-width: 100%; min-height: 1em; 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: 0.621714px; text-align: center; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><img class="rich_pages wxw-img" src="https://studioyszimg.yxj.org.cn/0A00007C017BBEED1E912FA10BFB2553.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; box-sizing: border-box ; overflow-wrap: break-word ; width: 677px ; visibility: visible ;"/></p><p style="padding: 0px; outline: 0px; max-width: 100%; min-height: 1em; 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: 0.621714px; text-align: center; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><img class="rich_pages wxw-img" src="https://studioyszimg.yxj.org.cn/0A00007C017BBEED1FD484A86E6E862A.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; box-sizing: border-box ; overflow-wrap: break-word ; width: 677px ; visibility: visible ;"/></p><p style="padding: 0px; outline: 0px; max-width: 100%; min-height: 1em; 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: 0.621714px; text-align: center; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><img class="rich_pages wxw-img" src="https://studioyszimg.yxj.org.cn/0A00007C017BBEED212A86976BCB6AA2.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; box-sizing: border-box ; overflow-wrap: break-word ; width: 677px ; visibility: visible ;"/></p><p style="padding: 0px; outline: 0px; max-width: 100%; min-height: 1em; 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: 0.621714px; text-align: center; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><img class="rich_pages wxw-img" src="https://studioyszimg.yxj.org.cn/0A00007C017BBEED2288052F63766D8E.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; box-sizing: border-box ; overflow-wrap: break-word ; width: 677px ; visibility: visible ;"/></p><p style="text-align: center;"><span style="line-height: 28px; font-size: 14px; color: rgb(136, 136, 136);">以上诸图不是典型的恶性征象,但因持续存在的磨玻璃结节仍要警惕与考虑的</span></p><p><br/></p><p style="padding: 0px; outline: 0px; max-width: 100%; min-height: 1em; 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: 0.621714px; text-align: center; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><img class="rich_pages wxw-img" src="https://studioyszimg.yxj.org.cn/0A00007C017BBEED24915E7F21E86ED1.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; box-sizing: border-box ; overflow-wrap: break-word ; width: 527px ; visibility: visible ;"/></p><p style="padding: 0px; outline: 0px; max-width: 100%; min-height: 1em; 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: 0.621714px; text-align: center; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><img class="rich_pages wxw-img" src="https://studioyszimg.yxj.org.cn/0A00007C017BBEED25C8CD040BB7C62D.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; box-sizing: border-box ; overflow-wrap: break-word ; width: 556px ; visibility: visible ;"/></p><p style="text-align: center;"><span style="line-height: 28px; font-size: 14px; color: rgb(136, 136, 136);">以上两图示显著的恶性特征:圆形或类圆形病灶,轮廓清楚,瘤肺边界清,病灶密度不均,桔色箭头示有血管贴边,关系密切;紫色箭头示有细毛刺征</span></p><p><br/></p><p style="text-align: center;"><span style="line-height: 28px; font-size: 14px; color: rgb(136, 136, 136);"><img class="rich_pages wxw-img" src="https://studioyszimg.yxj.org.cn/0A00007C017BBEED26EECF991EE27A3F.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; 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: 0.621714px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box ; overflow-wrap: break-word ; width: 507px ; visibility: visible ;"/></span></p><p style="text-align: center;"><span style="line-height: 28px; font-size: 14px; color: rgb(136, 136, 136);">上图示月牙铲征(砖色箭头)以及血管进入病灶(桔色箭头)</span></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">左上病灶恶性无疑,而且考虑至少是微浸润性腺癌,因为有血管征,有月牙铲征,有密度不均杂乱,大小也有1厘米到1.2厘米许。但是不是一定要马上处理,那倒不一定,因为2年也没什么进展,不过位置靠边上,局部楔形切除是可以考虑的。</span></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">下面我们再重点来看右上叶前段的病灶C,它的平扫是下面这样的:</span></p><p><br/></p><p style="padding: 0px; outline: 0px; max-width: 100%; min-height: 1em; 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: 0.621714px; text-align: center; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><img class="rich_pages wxw-img" src="https://studioyszimg.yxj.org.cn/0A00007C017BBEED2859246F1BB22B12.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; box-sizing: border-box ; overflow-wrap: break-word ; width: 512px ; visibility: visible ;"/></p><p style="padding: 0px; outline: 0px; max-width: 100%; min-height: 1em; 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: 0.621714px; text-align: center; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><img class="rich_pages wxw-img" src="https://studioyszimg.yxj.org.cn/0A00007C017BBEED298AB34D306E3AB7.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; box-sizing: border-box ; overflow-wrap: break-word ; width: 512px ; visibility: visible ;"/></p><p style="padding: 0px; outline: 0px; max-width: 100%; min-height: 1em; 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: 0.621714px; text-align: center; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><img class="rich_pages wxw-img" src="https://studioyszimg.yxj.org.cn/0A00007C017BBEED2AF19A1217304777.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; box-sizing: border-box ; overflow-wrap: break-word ; width: 512px ; visibility: visible ;"/></p><p style="padding: 0px; outline: 0px; max-width: 100%; min-height: 1em; 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: 0.621714px; text-align: center; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><img class="rich_pages wxw-img" src="https://studioyszimg.yxj.org.cn/0A00007C017BBEED2C1FA1BA4F77D8FA.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; box-sizing: border-box ; overflow-wrap: break-word ; width: 512px ; visibility: visible ;"/></p><p style="padding: 0px; outline: 0px; max-width: 100%; min-height: 1em; 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: 0.621714px; text-align: center; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><img class="rich_pages wxw-img" src="https://studioyszimg.yxj.org.cn/0A00007C017BBEED2DBB4FD947DC3759.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; box-sizing: border-box ; overflow-wrap: break-word ; width: 512px ; visibility: visible ;"/></p><p style="padding: 0px; outline: 0px; max-width: 100%; min-height: 1em; 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: 0.621714px; text-align: center; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><img class="rich_pages wxw-img" src="https://studioyszimg.yxj.org.cn/0A00007C017BBEED2EE78D561BB45FAA.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; box-sizing: border-box ; overflow-wrap: break-word ; width: 512px ; visibility: visible ;"/></p><p style="padding: 0px; outline: 0px; max-width: 100%; min-height: 1em; 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: 0.621714px; text-align: center; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><img class="rich_pages wxw-img" src="https://studioyszimg.yxj.org.cn/0A00007C017BBEED3037594316E8BD24.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; box-sizing: border-box ; overflow-wrap: break-word ; width: 512px ; visibility: visible ;"/></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">病灶较2020年6月明显增大,且与血管间隙不清,有的层面还有细毛刺样(紫色箭头),那么进一步的靶扫描细节如何呢?</span></p><p><br/></p><p style="text-align: center;"><span style="line-height: 28px; font-size: 14px; color: rgb(136, 136, 136);"><img class="rich_pages wxw-img" src="https://studioyszimg.yxj.org.cn/0A00007C017BBEED318C507D17F9F1C7.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; 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: 0.621714px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box ; overflow-wrap: break-word ; width: 677px ; visibility: visible ;"/></span></p><p style="text-align: center;"><span style="line-height: 28px; font-size: 14px; color: rgb(136, 136, 136);">病灶呈磨玻璃样密度</span></p><p><br/></p><p style="text-align: center;"><span style="line-height: 28px; font-size: 14px; color: rgb(136, 136, 136);"></span><img class="rich_pages wxw-img" src="https://studioyszimg.yxj.org.cn/0A00007C017BBEED330245B32349B7D5.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; 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: 0.621714px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box ; overflow-wrap: break-word ; width: 677px ; visibility: visible ;"/></p><p style="text-align: center;"><span style="line-height: 28px; font-size: 14px; color: rgb(136, 136, 136);">上图发现不是纯磨玻璃,密度还是比较高的</span></p><p><br/></p><p style="text-align: center;"><span style="line-height: 28px; font-size: 14px; color: rgb(136, 136, 136);"><img class="rich_pages wxw-img" src="https://studioyszimg.yxj.org.cn/0A00007C017BBEED34E2F4557B1C8484.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; 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: 0.621714px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box ; overflow-wrap: break-word ; width: 677px ; visibility: visible ;"/></span></p><p style="text-align: center;"><span style="line-height: 28px; font-size: 14px; color: rgb(136, 136, 136);">密度基本上是实性的,有分叶及细支气管穿行的样子,旁边还有另外一个纯磨玻璃结节,约4毫米许</span></p><p><br/></p><p style="padding: 0px; outline: 0px; max-width: 100%; min-height: 1em; 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: 0.621714px; text-align: center; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><img class="rich_pages wxw-img" src="https://studioyszimg.yxj.org.cn/0A00007C017BBEED367C3E286206569F.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; box-sizing: border-box ; overflow-wrap: break-word ; width: 677px ; visibility: visible ;"/></p><p style="padding: 0px; outline: 0px; max-width: 100%; min-height: 1em; 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: 0.621714px; text-align: center; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><img class="rich_pages wxw-img" src="https://studioyszimg.yxj.org.cn/0A00007C017BBEED37D85F476EA669FE.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; box-sizing: border-box ; overflow-wrap: break-word ; width: 677px ; visibility: visible ;"/></p><p style="padding: 0px; outline: 0px; max-width: 100%; min-height: 1em; 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: 0.621714px; text-align: center; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><img class="rich_pages wxw-img" src="https://studioyszimg.yxj.org.cn/0A00007C017BBEED392FDCBE73F93C0A.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; box-sizing: border-box ; overflow-wrap: break-word ; width: 677px ; visibility: visible ;"/></p><p style="padding: 0px; outline: 0px; max-width: 100%; min-height: 1em; 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: 0.621714px; text-align: center; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><img class="rich_pages wxw-img" src="https://studioyszimg.yxj.org.cn/0A00007C017BBEED3A4A60E46DD16F86.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; box-sizing: border-box ; overflow-wrap: break-word ; width: 677px ; visibility: visible ;"/></p><p style="text-align: center;"><span style="line-height: 28px; font-size: 14px; color: rgb(136, 136, 136);">上几图均示密度杂乱,有细小毛刺及浅分叶征</span></p><p><br/></p><p style="text-align: center;"><span style="line-height: 28px; font-size: 14px; color: rgb(136, 136, 136);"><img class="rich_pages wxw-img" src="https://studioyszimg.yxj.org.cn/0A00007C017BBEED3B9C9197173C9AAD.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; 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: 0.621714px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box ; overflow-wrap: break-word ; width: 677px ; visibility: visible ;"/></span></p><p style="text-align: center;"><span style="line-height: 28px; font-size: 14px; color: rgb(136, 136, 136);">上图示有微血管进入病灶或与它紧贴</span></p><p><br/></p><p style="text-align: center;"><span style="line-height: 28px; font-size: 14px; color: rgb(136, 136, 136);"><img class="rich_pages wxw-img" src="https://studioyszimg.yxj.org.cn/0A00007C017BBEED3CEF04884572089B.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; 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: 0.621714px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box ; overflow-wrap: break-word ; width: 677px ; visibility: visible ;"/></span></p><p style="text-align: center;"><span style="line-height: 28px; font-size: 14px; color: rgb(136, 136, 136);">上图示血管与病灶很近,并有纵隔侧胸膜牵拉(蓝色箭头)</span></p><p><br/></p><p style="text-align: center;"><span style="line-height: 28px; font-size: 14px; color: rgb(136, 136, 136);"><img class="rich_pages wxw-img" src="https://studioyszimg.yxj.org.cn/0A00007C017BBEED3E83CC6308E4E5D2.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; 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: 0.621714px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box ; overflow-wrap: break-word ; width: 677px ; visibility: visible ;"/></span></p><p style="text-align: center;"><span style="line-height: 28px; font-size: 14px; color: rgb(136, 136, 136);">上图示病灶基本实性,轮廓清楚,有纵隔侧胸膜牵拉(蓝色箭头),血管与病灶关系密切(桔色箭头),血管与病灶间间隙不清(黄色箭头)</span></p><p><br/></p><p style="text-align: center;"><img class="rich_pages wxw-img" src="https://studioyszimg.yxj.org.cn/0A00007C017BBEED407EDD70174012E5.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; 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: 0.621714px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box ; overflow-wrap: break-word ; width: 677px ; visibility: visible ;"/></p><p style="text-align: center;"><span style="line-height: 28px; font-size: 14px; color: rgb(136, 136, 136);">上图示病灶基本实性,轮廓清楚,血管与病灶关系密切(桔色箭头),血管与病灶间间隙不清(黄色箭头),病灶虽小,但有分叶(紫色箭头)</span></p><p><br/></p><p style="text-align: center;"><span style="line-height: 28px; font-size: 14px; color: rgb(136, 136, 136);"><img class="rich_pages wxw-img" src="https://studioyszimg.yxj.org.cn/0A00007C017BBEED420FB2857A7C81D0.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; 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: 0.621714px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box ; overflow-wrap: break-word ; width: 677px ; visibility: visible ;"/></span></p><p style="text-align: center;"><span style="line-height: 28px; font-size: 14px; color: rgb(136, 136, 136);">上图示病灶轮廓清楚,血管与病灶关系密切(桔色箭头),血管与病灶间间隙不清(黄色箭头),局部似见浅分叶(紫色箭头)</span></p><p><br/></p><p style="text-align: center;"><span style="line-height: 28px; font-size: 14px; color: rgb(136, 136, 136);"><img class="rich_pages wxw-img" src="https://studioyszimg.yxj.org.cn/0A00007C017BBEED43BA5DAE7A834A4A.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; 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: 0.621714px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box ; overflow-wrap: break-word ; width: 677px ; visibility: visible ;"/></span></p><p style="text-align: center;"><span style="line-height: 28px; font-size: 14px; color: rgb(136, 136, 136);">病灶贴边的血管(桔色箭头)以及少许磨玻璃(绿色箭头)</span></p><p><br/></p><p style="padding: 0px; outline: 0px; max-width: 100%; min-height: 1em; 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: 0.621714px; text-align: center; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><img class="rich_pages wxw-img" src="https://studioyszimg.yxj.org.cn/0A00007C017BBEED45683E75108DCA54.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; box-sizing: border-box ; overflow-wrap: break-word ; width: 677px ; visibility: visible ;"/></p><p style="padding: 0px; outline: 0px; max-width: 100%; min-height: 1em; 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: 0.621714px; text-align: center; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><img class="rich_pages wxw-img" src="https://studioyszimg.yxj.org.cn/0A00007C017BBEED469B5F6078B79351.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; box-sizing: border-box ; overflow-wrap: break-word ; width: 677px ; visibility: visible ;"/></p><p style="padding: 0px; outline: 0px; max-width: 100%; min-height: 1em; 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: 0.621714px; text-align: center; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><img class="rich_pages wxw-img" src="https://studioyszimg.yxj.org.cn/0A00007C017BBEED4804779A53F5CBC8.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; box-sizing: border-box ; overflow-wrap: break-word ; width: 677px ; visibility: visible ;"/></p><p style="text-align: center;"><span style="line-height: 28px; font-size: 14px; color: rgb(136, 136, 136);">以上几幅图也是示病灶瘤肺边界较清,部分偏磨玻璃成分,与血管关系密切以及浅分叶</span></p><p><br/></p><p style="text-align: center;"><span style="line-height: 28px; font-size: 14px; color: rgb(136, 136, 136);"><img class="rich_pages wxw-img" src="https://studioyszimg.yxj.org.cn/0A00007C017BBEED497A8BAA62DEB80A.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; 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: 0.621714px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box ; overflow-wrap: break-word ; width: 456px ; visibility: visible ;"/></span></p><p style="text-align: center;"><span style="line-height: 28px; font-size: 14px; color: rgb(136, 136, 136);">上图是后处理的图像,病灶明显分叶(紫色),密度不均,与胸膜牵拉(蓝色)</span></p><p><br/></p><p style="text-align: center;"><span style="line-height: 28px; font-size: 14px; color: rgb(136, 136, 136);"><img class="rich_pages wxw-img" src="https://studioyszimg.yxj.org.cn/0A00007C017BBEED4ABB758152FD9B52.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; 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: 0.621714px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box ; overflow-wrap: break-word ; width: 432px ; visibility: visible ;"/></span></p><p style="text-align: center;"><span style="line-height: 28px; font-size: 14px; color: rgb(136, 136, 136);">上图示病灶细毛刺(紫色箭头)以及血管征(桔色箭头),密度不均</span></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">从这些影像资料看,右上病灶显然是恶性的,而且几乎可肯定已经是浸润性腺癌了,大概乳头型或腺泡型为主,可能有少许贴壁成分,最好不要有实体型或微乳头成分(如果以后两都为主,发展应该更快一些,应该不是很符合的)。</span></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">这是个比较特殊的病例,最初以为A病灶是主病灶,予以靶扫描,后来复查关注B病灶,结果虽然B病灶是恶性的,但恶性程度不高,最后发现C病灶才是重点!而且同一个病人中展现了慢性炎性性质的混合磨玻璃结节、相对稳定的磨玻璃结节(考虑微浸润性腺癌)以及进展相对较快,恶性程度高些的实性结节,见证了该实性结节从微小似炎性灶直到明显增大成为典型的浸润性腺癌病灶。那么临床处理如何决策呢?我们再决定手术前再来仔细看下其他地方有没有结节,结果还真又有新发现:</span></p><p><br/></p><p style="text-align: center;"><span style="line-height: 28px; font-size: 14px; color: rgb(136, 136, 136);"><img class="rich_pages wxw-img" src="https://studioyszimg.yxj.org.cn/0A00007C017BBEED4BC6B20D3FC8A484.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; 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: 0.621714px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box ; overflow-wrap: break-word ; width: 677px ; visibility: visible ;"/></span></p><p style="text-align: center;"><span style="line-height: 28px; font-size: 14px; color: rgb(136, 136, 136);">右上叶前后段交界处有微小磨玻璃结节(病灶D),考虑不典型增生可能性大,不能除外原位腺癌</span></p><p><br/></p><p style="text-align: center;"><span style="line-height: 28px; font-size: 14px; color: rgb(136, 136, 136);"><img class="rich_pages wxw-img" src="https://studioyszimg.yxj.org.cn/0A00007C017BBEED4D8302337858B075.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; 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: 0.621714px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box ; overflow-wrap: break-word ; width: 677px ; visibility: visible ;"/></span></p><p style="text-align: center;"><span style="line-height: 28px; font-size: 14px; color: rgb(136, 136, 136);">右肺上叶后段有微小磨玻璃结节(病灶E),考虑不典型增生可能性大</span></p><p><br/></p><p style="text-align: center;"><span style="line-height: 28px; font-size: 14px; color: rgb(136, 136, 136);"><img class="rich_pages wxw-img" src="https://studioyszimg.yxj.org.cn/0A00007C017BBEED4F0FACD650C713EC.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; 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: 0.621714px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box ; overflow-wrap: break-word ; width: 677px ; visibility: visible ;"/></span></p><p style="text-align: center;"><span style="line-height: 28px; font-size: 14px; color: rgb(136, 136, 136);">右下叶背段有微小磨玻璃结节(病灶F),考虑不典型增生可能性大,不能除外原位腺癌</span></p><p><br/></p><p style="text-align: justify;"><strong><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">我们考虑外科的干预有以下方案可选,但各有利弊,逐一分析下:</span></strong></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">1、病灶C先楔形切除送检,若浸润性腺癌,则再行右上叶切除:好处是同时解决右上的CDE病灶,且符合实性结节得肺叶切除并清扫淋巴结的原则;坏处是左上还有病灶要手术,右下叶还有病灶,即使这次不开刀,以后仍可能需外科干预,肺功能影响大;</span></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">2、病灶C行右上叶前段切除,并纵隔淋巴结清扫或采样:肺切除范围小于肺叶,因左肺上叶与下叶还有病灶,妥协性行亚肺叶切除也说的过去。坏处是手术操作相对复杂些,用的切割缝合器比较多,医疗费用贵些。而且后段还有E病灶,前段与后段交界处还有D病灶,E是切不掉了,D能不能刚好切掉也难说;</span></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">3、病灶C行局部大楔形切除加纵隔淋巴结采样,包括其邻近的另一淡磨玻璃结节(姑且称它G病灶吧)也切掉,但不再进一步切叶或切段:这样做的好处是操作简单、风险小,切缘足够时一般不至于遗漏肺内播散病灶(其实也不太可能)。若纵隔淋巴结阴性,则与肺叶切除相比少了第11-14组淋巴结的结果(其实临床也一般难以取到第13、14组,肺段切除也多取到12组,有时有13组),与肺段切除相比少了第12-14组。可若病灶的病灶是高分化中或分化的,这么小的病灶已经有转移的概率非常低。若病理出来是实体型或微乳头型,那当然不行,得后续再行肺叶切除;坏处一是缺乏11-14组淋巴结有无转移的证据,二是DE病灶遗留在内。但若下叶的F病灶也不切的话,多留几处风险极低的微小磨玻璃结节又何妨?况且随访若进展,还可再考虑切除或其他局部治疗措施(这次只楔切的话,肺功能影响不大);</span></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">4、病灶B考虑可同期局部切除,也可考虑分期局部切除,如果在大医院也可能会选择固有段或前段切除,但若确实是微浸润性腺癌或浸润性腺癌的贴壁为主型,局部切除效果与肺段切除又没有区别,何况她右侧还有肺癌病灶,也是要手术的,从妥协性角度,也是局部切除够了;</span></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">5、右下叶F病灶如果考虑切除,因为无法楔切,那么将考虑慢性炎可能性大的A病灶一并切除,行右下叶背段切除,也可考虑,毕竟没有病理,那慢性炎是不是百分之百,仍是未知数,反正还有F灶,切背段也可考虑。不过话说回来,即使把F病灶切了又如何?上叶还有DE病灶呢。难不成,右上叶切除加下叶背段切除,再加左上叶局部切除?这样虽然一网打尽,但对于目前有5处病灶都考虑恶性范围的病人来讲,谁能认为她的右下叶基底段、左下叶等其他肺上没有微小磨玻璃结节?或者以后不会再新长?所以本着解决有风险的病灶为主,兼顾肺功能维护及为以后干预处理留下空间来讲,我们建议是“右上叶部分切除(基本切除大部分前段,但不游离段门)+纵隔淋巴结清扫(采样)+左上叶部分切除(左侧术前先定位)”。左上同期或分期由同事与家从商量后自己定,最后同事选择同期。</span></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">下面是标本与病理结果:</span></p><p><br/></p><p style="text-align: center;"><span style="line-height: 28px; font-size: 14px; color: rgb(136, 136, 136);"></span></p><p style="padding: 0px; outline: 0px; max-width: 100%; min-height: 1em; 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: 0.621714px; text-align: center; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><img class="rich_pages wxw-img" src="https://studioyszimg.yxj.org.cn/0A00007C017BBEED50715E447BF1470A.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; box-sizing: border-box ; overflow-wrap: break-word ; width: 677px ; visibility: visible ;"/></p><p style="padding: 0px; outline: 0px; max-width: 100%; min-height: 1em; 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: 0.621714px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><br/></p><p style="padding: 0px; outline: 0px; max-width: 100%; min-height: 1em; 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: 0.621714px; text-align: center; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><img class="rich_pages wxw-img" src="https://studioyszimg.yxj.org.cn/0A00007C017BBEED52A4F2F12E22311E.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; box-sizing: border-box ; overflow-wrap: break-word ; width: 677px ; visibility: visible ;"/></p><p style="text-align: center;"><span style="color: rgb(136, 136, 136); font-size: 14px;">右上叶C病灶确实是浸润性腺癌,腺泡为主,部分乳头型。</span><br/><span style="line-height: 28px; font-size: 14px; color: rgb(136, 136, 136);"></span></p><p><br/></p><p style="text-align: center;"><span style="line-height: 28px; font-size: 14px; color: rgb(136, 136, 136);"></span></p><p style="padding: 0px; outline: 0px; max-width: 100%; min-height: 1em; 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: 0.621714px; text-align: center; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><img class="rich_pages wxw-img" src="https://studioyszimg.yxj.org.cn/0A00007C017BBEED54141F46185E2457.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; box-sizing: border-box ; overflow-wrap: break-word ; width: 677px ; visibility: visible ;"/></p><p style="padding: 0px; outline: 0px; max-width: 100%; min-height: 1em; 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: 0.621714px; text-align: center; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><img class="rich_pages wxw-img" src="https://studioyszimg.yxj.org.cn/0A00007C017BBEED557D66F06EA8BB72.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; box-sizing: border-box ; overflow-wrap: break-word ; width: 677px ; visibility: visible ;"/></p><p style="text-align: center;"><span style="color: rgb(136, 136, 136); font-size: 14px;">左上叶是微浸润性腺癌</span><br/><span style="line-height: 28px; font-size: 14px; color: rgb(136, 136, 136);"></span></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">反思:1、在肺结节多发越来越常见的情况下,我们本来的思维是关注主病灶,兼顾次病灶,但这个病例告诉我们主病灶是会变的,特别是实性的小结节要提高警惕;2、实性结节即使开始不太像恶性,而是像炎性,但仍需持续关注,有许多实性结节为表现的肺癌,它不一定都是从磨玻璃结节发展而来,而是一开始就是实性的;3、对于多发结节,追求一网打尽可能并不适宜,还需要更多的研究与更长的随访时间来综合评估,找到最为合理的治疗方案。</span></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);"><br/></span></p><p style="text-align: center;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);"><img src="https://studioyszimg.yxj.org.cn/om3dcjvrzts.png" title="" alt="" style="max-width:100%;"/></span></p><p><br/></p>

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