本文将从肺磨玻璃病变的诊断，治疗及预后来浅谈该类疾病。

一般小于8毫米的肺磨玻璃病变不建议患者手术，即使高度怀疑纯磨玻璃病变为原位癌或微小浸润癌，也不建议患者立即手术治疗，建议定期复查。但是有以下几种危险因素的可以考虑手术:1.磨玻璃结节进行增大；2.结节实性成分较多，混合性磨玻璃结节；3.实性结节旁边有云雾状改变，类似卫星灶；4.病变部位形状不规则。

对于磨玻璃肺结节有几点值得我们探索的，比如PET在该类病变中的应用价值?一般普遍认为PET对这类结节诊断的意义不大，但是高分辨率和带呼吸门控的PET对该类结节还是值得探索的，这也是目前对于该类病变诊断研究的突破口和研究热点。其次是肺穿刺活检术在这类结节中的诊断意义，及诊断地位还需进一步发掘。

在治疗方面，对于这类结节，目前标准的治疗方式还是手术治疗，手术方式包括肺楔形切除术，肺段切除术，联合肺亚段切除术，甚至包括肺叶切除术，但肺叶切除在没有确诊的磨玻璃结节的治疗中应该极其慎重。

射频消融，冷冻治疗，甚至放疗等其他治疗方式，在身体条件不适合手术的情况下，可以作为治疗该类病变的补充治疗，但是不应该成为主要治疗手段。

单发的肺磨玻璃病变治疗效果非常好，即使该类结节为肺原位癌或肺微小浸润癌，术后基本无复发，远期疗效极好。

This article will discuss the diagnosis, treatment and pretreatment of pulmonary ground-glass disease.

In general, patients with ground-glass lung lesions smaller than 8 mm are not recommended for surgery. Even if pure ground-glass lesions are highly suspected to be carcinoma in situ or microinvasive carcinoma, immediate surgical treatment is not recommended for patients, and regular review is recommended. However, surgery can be considered if there are such risk factors :1. Enlargement of ground glass nodules; 2. There were more solid components of the nodules, mixed ground glass nodules, 3. There were cloud like changes beside the solid nodules, similar to satellite foci, 4. The lesion is irregularly shaped.

There are several points worth exploring for ground-glass pulmonary nodules, such as the application value of PET in these lesions? It is generally believed that PET is of little significance in the diagnosis of these nodules. However, high-resolution PET with respiratory gating is still worth exploring for these nodules. Secondly, the diagnostic significance of lung puncture biopsy in these nodules and its diagnostic status need to be further explored.

In terms of treatment, the current standard of treatment for these nodules is surgical treatment, including cuneiform resection, segmental resection, combined subsegmental resection, and even lobectomy. However, lobectomy should be taken with extreme caution in the treatment of undiagnosed ground glaucous nodules.

Other treatments, such as radiofrequency ablation, cryotherapy, and even radiotherapy, can be used as a supplement to the treatment of these lesions in cases where surgery is not suitable, but should not be the primary treatment.

The treatment effect of single pulmonary ground glass lesions is very good, even if the nodules are in situ lung carcinoma or small invasive lung carcinoma, there is basically no postoperative recurrence, and the long-term curative effect is excellent.

作者简介：

Orhan K Oz

Professor & Division Chief, Radiology

Charles and Jane Pak Center for Mineral Metabolism and Clinical Research

Nuclear Medicine

Division Chief of Nuclear Medicine.

刘俊

医学博士、主任医师、副教授、硕士研究生导师

武汉大学中南医院、胸外科副主任

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