肺磨玻璃结节亚肺叶切除术中的动态切缘 策略——基于术前影像亚型与多模态术中技术

Dynamic Margin Strategy in Sub-Lobar Resection for Lung Ground-Glass Nodules—Based on Preoperative Imaging Subtypes and Multimodal Intraoperative Techniques

摘要: 目的：探讨针对以磨玻璃结节(GGO)为特征的早期肺癌，在亚肺叶切除术中实施个体化“动态切缘”(Dynamic Margin)策略的理论基础与实践路径。方法：综述GGO的影像–病理学特征，剖析当前国际切缘指南的共识与分歧，并总结术中导航与切缘评估技术的最新进展。结果：传统“一刀切”的切缘标准无法适应GGO亚型(纯磨玻璃结节[pGGO]与混合性磨玻璃结节[mGGO])的生物学异质性。基于实性成分占比(consolidation tumor ratio, CTR)的精准风险分层可明确不同亚型GGO的侵袭潜能与复发风险，国际指南对切缘距离的推荐存在显著差异，而三维重建、支气管镜定位、吲哚菁绿(ICG)荧光导航等术中技术及冰冻病理、分子成像等切缘验证手段，为个体化切缘决策提供了技术支撑。讨论：“动态切缘”策略通过术前影像分层制定初始计划，术中整合实时导航与多维度验证技术动态调整切除范围，可在确保肿瘤根治性的同时，最大限度地保留肺功能。结论：“动态切缘”整合了多学科前沿技术，有望优化早期GGO型肺癌的手术决策，实现肿瘤控制与功能保存的最佳平衡。

Abstract: Objective: To explore the theoretical basis and practical pathway of implementing an individualized “dynamic margin” strategy during sublobar resection for early-stage lung cancer characterized by ground-glass nodules (GGO). Methods: We reviewed the imaging-pathological characteristics of GGO, analyzed the consensus and discrepancies in current international margin guidelines, and summarized the latest advances in intraoperative navigation and margin assessment technologies. Results: The traditional “one-size-fits-all” margin standard is not adaptable to the biological heterogeneity of GGO subtypes (pure ground-glass nodules [pGGO] and mixed ground-glass nodules [mGGO]). Precision risk stratification based on the consolidation tumor ratio (CTR) can clarify the invasive potential and recurrence risk of different GGO subtypes. There are significant differences in margin distance recommendations among international guidelines, while intraoperative technologies such as three-dimensional reconstruction, bronchoscopic localization, and indocyanine green (ICG) fluorescence navigation, as well as margin verification methods including frozen section pathology and molecular imaging, provide technical support for individualized margin decision-making. Discussion: The “dynamic margin” strategy formulates an initial plan through preoperative imaging stratification, dynamically adjusts the resection range by integrating real-time navigation and multi-dimensional verification technologies during surgery, and can maximize lung function preservation while ensuring oncological radicality. Conclusion: The “dynamic margin” strategy, integrating cutting-edge multidisciplinary technologies, is expected to optimize surgical decision-making for early-stage GGO-type lung cancer, achieving the best balance between tumor control and functional preservation.