1cm grinding glass knot cutting the lung cord?Pulmonary defenders plan to break the cognition!

Author:Cancer Channel of the Medical Time:2022.09.08

*For medical professionals for reading reference

Let patients who are not surgical or need lobe resection and sub -segment resection retain the lung function.

The lung grinding glass nodules are regarded as the "precursor" of lung cancer in the people. If a lung grinding glass nodules appear, people always worry about it and go to the hospital for several rounds. It is best to cut it with peace of mind.

This year, Ms. Zhu (pseudonym) found that there were several grinding glass nodules during the physical examination, which made her panic! Hurry up at the outpatient clinic at Renji Hospital affiliated to Shanghai Jiaotong University.

After Professor Chi Jiachang's consultation, he found that Ms. Zhu's main lesion was a grinding glass nodule with a diameter of 12 mm. It was located in the clung part. If the surgery was surgery, the lung lobe may be removed. Real the same effect. Considering the retaining lung function, Professor Chi suggested that she melted.

Ms. Zhu tangled for several days and went to perform surgery to remove her lung leaves. As a result, lung function was greatly affected after surgery, and regret it!

Poor pulmonary grinding glass nodules are necessary, but for the pulmonary grinding glass nodules, in order to ensure safety, the entire lobe is removed.

Can Professor Chi's ablation really achieve the effect of surgical resection when the lung lobe is retained? Professor Chi Jiachang, a special invitation to the "Medical Tumor Channel", shared the "Pulmonary Protector Program" to see if patients with glass nodules in the cliff have new choices.

1cm Puretic Glass Nodule,

Is it necessary to remove the lung lobe?

Pulmonary grinding glass nodules are very common. Once the patient is found to have a pulmonary grinding glass nodule, after long -term follow -up, the grinding glass nodules are increased, density increases, or other imaging performance gradually tends to be malignant, which may indicate pre -cancer lesions.

Surgical treatment is still standard treatment for suspicious and malignant pulmonary grinding glass nodules. Surgical methods include wedge resection, pulmonary section resection, and lobe resection.

The position of the glass nodule is very important for the choice of surgery.

Professor Chi Jiachang introduced:

"If the location of the lesion is very close to the thoracic membrane, the surgeon can easily remove a small piece of lobe tissue. We call it a wedge -shaped resection.

If the surgical range is larger, the doctor may remove the lung segment, that is, the section cut.

However, the position of some lesions is close to the honeycomb, and a safe resection boundary cannot be guaranteed. At this time, traditional surgical treatment can only be removed. "

The lungs are divided into 5 pulmonary lobes, and each lung lobe is undertaken some of the respiratory function. If the lung lobe is removed, 10%-25%of the lung function will be lost. Young patients have good lung function and will not affect their quality of life. The lung function of elderly patients is relatively weak, and the impact of pulmonary lobe removal on respiratory function is more obvious.

In fact, when many patients perform lobe resection, the lesion is only about 1cm.

"It is a pity to remove the entire lung lobe for such a small lesion to affect the respiratory function. Therefore, we have been discussing with thoracic surgery whether it can handle the early grinding glass nodules that meet the early JCOG0804 standards." Professor Chi Chi Share.

The "Pulmonary Guardian Plan" does not need to cut the lungs,

Breaking cognition!

Everyone must have doubts about the ablation- "The ablation is not a malignant organization, will it recur? Will it be unsafe?"

Professor Chi Jiachang said: "Compared to other physical tumors, the pulmonary grinding glass nodules are just a" metamorphic lung tissue ', and its tumor cells are all in the alveolar cavity without invading the quality. The internal tumor tissue is fully discharged to achieve the effect of traditional surgical resection. To completely melt the tumor cells with glass nodules, the microwave needle must be accurately worn in the lesion. "

The anatomical structure of the cliff is complicated, and the passage of the atmosphere and the passage of large blood vessels. If the surgery is accidentally, it will easily damage the large blood vessels and cause serious consequences. Therefore, patients with lesions in the cliffs are very cautious in puncture biopsy and ablation. The microwave acupuncture used in non -puncture microwave ablation antenna is blunt. It can pass through the lung tissue and grinding glass nodules (except that the solid ingredients are more), but do not pierce the surrounding blood vessels, bronchies and other tissue.

Non -puncture microwave needles will not pierce blood vessels

Non -puncture microwave needle

However, the traditional microwave needle is more acute, and it only needs to touch the blood vessels and other structures.

Traditional microwave tit -tat sharpness can easily cause blood vessels and trachea injuries

In addition, the heating site and power of non -puncture microwave needles are more suitable for lung grinding glass nodules. Its heat is more uniform, lower, and the parts are moving forward, which can bring better ablation effects.

A large number of clinical practice confirms,

The "Pulmonary Defenseer Plan" is safe and effective

Professor Chi Jiachang said: "In recent years, we have worked closely with thoracic surgery. Since 2015, I have regarded JCOG0804 as a standard for our ablation. Through continuous attempts, accumulation and summary, we have established our own indications. In the patient group who needs to be treated with lung lobe, choose the right patient, and adopt new non -puncture microwave ablation antennas for ablation. At present, hundreds of successful cases that have kept lung lobe have been accumulated. In the past, there were restrictions on surgical history or basic diseases that could not be surgery. It was also cured through microwave ablation therapy and protected its lung function. "

Professor Chi shared a case of a non -stingy microwave microwave ablation antenna for the treatment of pulmonary grinding glass nodules. The patient has two grinding glass nodules, one of which is located in the cliff and surrounds the blood vessels to deal with it.

Patients choose to use microwave ablation, the puncture needle during the operation accurately reaches the lesion site, and the peripheral lesions of the blood vessels are melted "multi -needle and multi -plane" without damage the surrounding blood vessels. 24 -month follow -up shows that the original grinding glass nodule is no residual.

From left to right are the first pins, the 2nd needle, and the 3rd needle

After the follow -up follow -up, it was found that there was no lesion residue

There are many such cases. "In the past 4 years, 167 patients have been treated with non -puncture microwave ablation antennas. Many patients have followed up for more than 3 years and the recurrence rate is 0. It is confirmed that non -puncture microwave ablation antenna therapy is safe and effective. I hope clinical research through clinical research Verify their curative effects and safety at a larger sample amount, so that more patients with early pulmonary grinding glass nodules avoid lobe resection. "

Which lung grinding glass nodules

Can you use the "Pulmonary Defenders"?

Since the "lung protector plan" is safe and effective, which patients with pulmonary abrasive glass nodules meet the treatment conditions?

Professor Chi Jiachang summarizes that patients with pulmonary grinding glass nodules who can be treated with non -puncture microwave ablation antenna shall meet the following standards:

1. Sliming glass lesions need to meet the early tumors of JCOG0804 research standards. The morphology is irregular or even crab -like lesions, high density and unevenness, more solid ingredients, blood vessels, and infringement of hypertrophic pleura. It may not be suitable;

2. For patients who cannot obtain pathology, the imaging must be highly typical of early lung cancer with a typical grinding glass nodule sample, and the lesions increase during the follow -up period, and the follow -up time is> 24 months.

If the glass lesions need to be removed with lung lobe, you will consider whether you can try microwave ablation before surgery. This means that patients do not have to choose one in surgery and microwave ablation, but to provide patients with another treatment opportunity before performing surgery.

At present, Professor Chi Jiachang's clinical trial has been registered and has begun to enter the group of patients with pulmonary grinding glass nodules.

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