"The metaphysical one is called Tao, and , the physical one is called ," comes from "The Book of Changes·Xici". The original saying is: "The metaphysical one is called Tao, and the physical one is called instrument. Transformation and decree is called change, pushing and acting is called Tong, and lifting and wrongly raising the people of the world is called career." This means that what is invisible above the body is called Tao, what is visible below the body is called instrument, what is transformed and cut into all things is called change, and what is moved and moved is called Tong, and what is applied to the people of the world is called career. --Excerpted from "The Book of Changes·Xici" of a certain Du
Doctor Hou's popular science, focusing on lung nodules, a unique perspective, must be original. Compared with the mass-falsed paper factory, I just abandoned the professional paper writing that I am not good at and turned to discuss medicine and theory, but I have no worries about false punishment.
Today’s topic, let’s discuss the two powerful tools for lung ground glass nodules: CT imaging diagnosis and surgical resection .
The creative passion of this article comes entirely from the elderly who was accidentally "come with each other" not long ago and was discharged from the hospital after my surgery.
recalled that day, he was entrusted by a friend to read the chest CT images of his family's physical examination in the HIS system in the hospital. After entering his name, the CT images displayed were definitely not what he described on the phone, "the physical examination report had multiple small nodules on both lungs." This was obviously a mixed grinding glass nodule that existed independently in the lower right lung, with a diameter of about 2.5cm!
quickly called to verify, it turned out to be a false alarm with a duplicate name. The relatives of friends naturally met the multiple nodules and had no diagnostic value. They were just annual follow-up.
But how should this lung nodule that accidentally "breaks into my sight"? In fact, as a doctor, especially a municipal hospital that survives in the middle and a young doctor who lacks many halos, sometimes too attentive actions will be hated. However, when I saw the CT report of the elderly’s conclusion of “considering inflammatory lesions in the lungs”, the strong concept of first-diagnosis responsibility system prompted me not to take it lightly or let it go. Since I accidentally saw an image of her lungs, this is a kind of "fate"!
searched for the root cause. This old man is a patient who is admitted to the respiratory department and plans to "pulmonary inflammation and cough up blood" to prepare for anti-infection treatment. While I was carefully reading the film and analyzing it, the doctor in charge was actually writing the consultation record. I called the doctor to tell the doctor's sister directly: "I will answer this consultation, I will write it. The consultation of this old man is different from the general brief, and it must be taken seriously."
Doctor Hou has a long habit of analyzing a lung nodule and making a conclusion, he does not look at the image report, nor does he look at CT films with too little information. He must conduct digital image analysis and refer to other conclusions to make a personal diagnosis.
The nodule of the elderly has existed for two years. After being initially called "inflammatory lesions", there has never been any re-examination or treatment in two years, because there is no discomfort. If it weren't for the coughing of blood occasionally when I got up a few days ago, we would be destined to be unable to "get together".
This is my preliminary consultation opinion: consider ground-glass nodule lung cancer stage IAC with alveolar collapse! It is recommended that family members conduct face-to-face consultations, explain CT images face-to-face in detail and discuss the best clinical strategies.
family members arrived as promised. Facing the computer screen of the "Pulmonary Nodule Accurate Digital Image Analysis Platform" that I personally "accumulated", I listed the diagnostic evidence one by one: abnormal vascular traffic signs, tracheal dilation distortion, and pleural pulling, especially the changes in contractility that are different from benign diseases such as "bronchiectasis". In the final visual VR reproduction, the family members finally understood the profound meaning of Dr. Hou's face-to-face diagnosis: you can't wait any longer, you can't wait any longer! If I had been slacking off in the "inflammatory" worry-free moment, but at this moment, I hope she cherishes and continues our "fate".
"Thank you for your detailed analysis. I have never experienced CT image analysis convinced me, and the surgical effect data of ground glass nodular lung cancer infiltration stage (IAC) with a solid component less than 30% made our family feel hopeful. We decided to follow your clinical strategy for surgery"! This kind of communication like a doctor and a friend and this sense of purity in doing a doctor really makes Dr. Hou happy.
surgery was performed as scheduled. This "dosal nodule" thoracoscopic minimally invasive surgery that is very common in our thoracic surgery department, is really quite popular. From top to bottom, it seems to have become an introductory move for thoracic surgery. Even so, I still carried out a detailed preoperative three-dimensional surgical plan for the elderly according to habit: two abnormally thickened and mutated right lung dorsal arteries, fusion caused by the pulling of the upper and lower lobe oblique fissures for two years, and even partial resection of the posterior upper lobe that is necessary for tumor adhesion...
However, the primary concept is that in the face of such a type of mixed ground glass nodules, the image accuracy has not changed significantly in two years, the solid composition is less than 30%, and there is a high probability that there will be no high-risk type of "micro-nipple-shaped, solid-shaped" type; the sub-segment a located at the top of the dorsal segment, the most extrinsic visceral layer or the upper lung locality, and the multimodal measurement of the nodules is still less than 3cm... According to industry consensus, JCOG0804 and other research results, this 72-year-old man does not need to undergo lobectomy!
surgery is just a treatment method for trauma. The smallest trauma may have the same treatment effect, greater trauma, the same life trajectory, or worse quality of life. How to weigh the pros and cons is actually the essence of my "fate" with this old man.
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is 2cm away from the nodule, including the local expansion and resection of the lower right lung dorsal segment of the posterior segment of the upper lung, and the recovery is smoothly carried out and smoothly. The frozen pathology in the operation and the final wax block pathology both confirmed the judgment of preoperative images. There is no "micro-nipple, solid" component, but it is a bit regrettable that there is local infiltration of the visceral pleura, and the T stage has been upgraded from T1c to T2a, which is still an early stage lung cancer stage. Anti-tumor treatment is still not necessary for this type of advanced surgery.
perfect ending, perfect fate. After reading this, everyone seems to have forgotten the title of this article: CT imaging diagnosis and surgical resection of lung ground glass nodules, which one is the best?
This article begins with the saying "metaphysical is called Tao". If Dr. Hou regards medical skills as supreme, then the medical methods adopted by the lung ground glass nodules from beginning to end are "metaphysical is called tools": For the imaging department, he is naturally proficient in CT imaging diagnosis of lung nodules. For the thoracic surgery lancet, the surgery is superbly removed with nodules and is as familiar as taking pictures...
"A gentleman is not a weapon". From the perspective of a doctor, perhaps Confucius old man will angrily scold Dr. Hou for his nonsense and misinterpretation. But the old man’s original intention is not: The gentleman should be as ubiquitous as the function of Tao, and not have only one specific function like the instrument. cannot be limited by one skill, can only learn one or two crafts, can only seek to make a fortune in career, but when "ambition" is "the way", you must understand the profound way of heaven that everyone cannot grasp from the world of everything, so as to respond to all changes with the unchanging.
As a doctor who is exposed to ground glass nodules in lungs, if he can judge the type of ground glass nodules based on the research of CT images, disease development trends, dynamic analysis and comparison, and evidence collection concepts, to improve the cognitive performance of imaging anatomy and imaging pathology, and to form a responsible rather than ambiguous diagnosis, he will judge the type of ground glass nodule lung cancer based on this, grasp the surgical indications according to regular clinical guidelines, and design the hand according to different individuals The surgical plan makes the final clinical decision based on the pros and cons of the life trajectory...
This is the "integrated diagnosis and treatment concept of lung nodules" that Dr. Hou has long advocated and insisted on. It also has the personal definition of "precise integrated diagnosis and treatment of lung nodules". It is not limited to a certain major, but also emphasizes the "change" and "transmission" of multiple disciplines. What is applied to the people of the world is like the opening sentence, which is called career.
"Tao" is the law. In the end, following the "Tao" of lung glass nodules under the medical tract is the best. Diagnosis and "grinding" based on "Tao" and elimination of "demons" based on "Tao" is the place for CT diagnosis and surgical resection. It is indispensable and complementary!
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