[Clinical diagnosis and treatment of multiple pulmonary nodules].

CT screening has markedly reduced the lung cancer mortality in high-risk population and increased the detection of early-stage pulmonary neoplasms, including multiple pulmonary nodules, especially those with a ground-glass appearance on CT. Multiple primary lung cancer (MPLC) constitutes a specific subtype of lung cancer with indolent biological behaviors, which is predominantly early-stage adenocarcinoma. Although MPLC progresses slowly with rare lymphatic metastasis, existence of synchronous lesions and distributed location of these nodules still pose difficulty for the management of such patients. One single operation is usually insufficient to eradicate all neoplastic lesions, whereas repeated surgical procedures bring about another dilemma: whether clinical benefits of surgical treatment outweigh loss of pulmonary function following multiple operations. Therefore, despite the anxiety for treatment among MPLC patients, whether and how to treat the patient should be assessed meticulously. Currently there is a heated discussion upon the timing of clinical intervention, operation mode and the application of local therapy in MPLC. Based on clinical experience of our multiple disciplinary team, we have summarized and commented on the evaluation, surgical treatment, non-surgical local treatment, targeted therapy and immunotherapy of MPLC in this article to provide further insight into this field.CT筛查的开展显著降低了肺癌高危人群的死亡率，同时也提高了早期肺癌的诊断率，包括肺部多发结节尤其是多发磨玻璃病灶的检出。多原发肺癌构成了肺癌的一种特殊类型，以早期腺癌居多，生物学行为较为惰性，虽然病程进展通常较缓慢、少有淋巴结转移，但病灶数量多、分布位置散在仍然增加了临床诊疗的难度。多发肺结节患者往往不能通过手术一次性切除所有病灶，而反复进行外科手术治疗则带来一个两难问题，即手术切除病灶给患者带来的临床获益是否大于患者肺功能损失造成的潜在风险。因此，尽管临床工作中常见因焦虑心态而急于进行治疗的多发肺结节患者，治疗指征的把控和治疗方式的选择仍需全面考量。目前针对多发结节介入干预的时机、外科手术治疗的方式和局部治疗的地位仍有较多争议，尚无统一标准。笔者及所在的多学科诊疗团队就临床上积累的肺部多发结节诊疗经验，对肺多发结节的诊断评估、外科手术治疗、非手术局部治疗、靶向和免疫辅助治疗以及临床随访进行了详细评述。.