肺磨玻璃结节治疗的研究进展

Research Progress on the Treatment of Lung Ground-Glass Nodules

摘要: 肺磨玻璃结节(ground-glass nodules, GGNs)是肺癌筛查中常见的CT影像学表现，多数呈惰性生长、进展缓慢，但部分可进展为浸润性肺癌。因此，对GGNs进行准确的危险分层对于指导临床决策具有重要意义，低危结节以观察随访为主，高危结节则需及时治疗干预。近年来，随着外科手术、影像引导下微创消融及立体定向体部放射治疗(stereotactic body radiotherapy, SBRT)等局部治疗技术的不断发展，GGNs患者的治疗选择日趋多样化。不同治疗方式在适应证、局部控制效果、肺功能保护及并发症等方面各具特点，如何根据患者及病灶特征制定个体化治疗策略仍是临床关注的重点。本文围绕GGNs的主要局部治疗方式，对外科手术、射频消融(radiofrequency ablation, RFA)、微波消融(microwave ablation, MWA)、冷冻消融(cryoablation, CA)及SBRT的临床应用现状、治疗效果、安全性及研究进展进行综述，并分析目前存在的问题及未来发展方向，以期为GGNs的精准诊疗和临床决策提供参考。

Abstract: Ground-glass nodules (GGNs) are common CT imaging findings in lung cancer screening. Most GGNs exhibit indolent growth and slow progression, whereas a subset may progress to invasive lung cancer. Therefore, accurate risk stratification of GGNs is essential for guiding clinical decision-making. Low-risk nodules are generally managed with surveillance, whereas high-risk nodules require timely therapeutic intervention. In recent years, with the continuous advancement of local therapeutic techniques including surgical resection, image-guided minimally invasive ablation and stereotactic body radiotherapy (SBRT), the treatment options for patients with GGNs have become increasingly diversified. Different treatment modalities have their respective characteristics in terms of indications, local control efficacy, pulmonary function preservation and complication profiles. How to formulate individualized therapeutic strategies according to patient and lesion features remains a key clinical concern. Focusing on the major local therapies for GGNs, this article reviews the current clinical application, therapeutic efficacy, safety and research progress of surgical resection, radiofrequency ablation (RFA), microwave ablation (MWA), cryoablation (CA) and SBRT. In addition, it analyzes the existing problems and future directions, so as to provide references for precise diagnosis and treatment as well as clinical decision-making of GGNs.