WEBVTT00:00:04.400 --> 00:00:05.760嗯大家晚上好00:00:05.760 --> 00:00:07.840我是复旦大学附属金山医院00:00:07.840 --> 00:00:09.440呼吸科的王静医生00:00:09.440 --> 00:00:10.400那么我今天呢00:00:10.400 --> 00:00:12.840跟大家一起分享的内容是00:00:12.840 --> 00:00:15.220肺癌的原因和如何预防00:00:16.840 --> 00:00:17.560嗯首先呢00:00:17.560 --> 00:00:20.380我们来看一下肺癌的原因有哪些00:00:20.920 --> 00:00:22.540为什么会出现肺癌00:00:22.680 --> 00:00:24.340也就是它的发病机制00:00:25.240 --> 00:00:25.480嗯00:00:25.480 --> 00:00:27.800那么首先我们大家都知道吸烟呢00:00:27.800 --> 00:00:30.980跟肺癌的这个关系非常密切啊00:00:31.200 --> 00:00:34.380嗯这里面包括到这个主动吸烟00:00:34.520 --> 00:00:35.740主动吸烟会00:00:36.000 --> 00:00:37.960烟草当中的一些有害的物质00:00:37.960 --> 00:00:39.640比如说像焦油啊00:00:39.640 --> 00:00:42.160或者是尼古丁这样的一些致癌物呢00:00:42.160 --> 00:00:44.160会被我们吸到肺里去00:00:44.160 --> 00:00:45.120那么这样的话00:00:45.120 --> 00:00:46.520长期吸烟的话00:00:46.520 --> 00:00:50.020就会导致得肺癌的风险会显著增加00:00:50.240 --> 00:00:51.040那么00:00:52.800 --> 00:00:54.240除了主动吸烟以外00:00:54.240 --> 00:00:56.100像被动吸烟的人群00:00:56.240 --> 00:00:57.640呃也他自己不吸烟00:00:57.640 --> 00:01:00.240但是环境当中边上的人有人抽烟00:01:00.240 --> 00:01:02.540他会被动的吸入这种烟雾00:01:02.640 --> 00:01:03.880同样会增加00:01:03.880 --> 00:01:06.840非吸烟者患肺癌的这个风险00:01:06.840 --> 00:01:10.200尤其如果说这个环境非常密闭的话00:01:10.200 --> 00:01:12.060那么这个影响会更大一些00:01:12.480 --> 00:01:14.880那么现在很多人他就是不抽烟00:01:14.880 --> 00:01:17.300他说那我吸电子烟00:01:17.440 --> 00:01:19.240但事实上电子烟的话00:01:19.240 --> 00:01:22.040虽然说他认为比传统的香烟啊00:01:22.040 --> 00:01:23.520危害会小一些00:01:23.520 --> 00:01:26.600但是呢他长期对于健康的影响呢00:01:26.600 --> 00:01:28.080也并不是很明确的00:01:28.080 --> 00:01:30.480他同样会有很多的烟雾00:01:30.480 --> 00:01:31.960里面的一些成分呢00:01:31.960 --> 00:01:35.720可能也是一些嗯会沉积在气道里面00:01:35.720 --> 00:01:37.760会对我们的气道产生影响00:01:37.760 --> 00:01:38.120所以00:01:38.120 --> 00:01:41.100它同样会可能跟肺癌的风险相关00:01:41.120 --> 00:01:42.520你不管是嗯00:01:42.520 --> 00:01:44.780吸的中纸质烟还是什么烟00:01:44.880 --> 00:01:48.300电子烟都是不太建议去使用气啊00:01:49.560 --> 00:01:51.680那么除了这个吸烟00:01:51.680 --> 00:01:53.960对于肺癌的影响以外呢00:01:53.960 --> 00:01:55.360还有非常重要的一部分00:01:55.360 --> 00:01:56.520是这种环境的00:01:56.520 --> 00:01:58.560污染像环境的污染当中00:01:58.560 --> 00:01:59.720空气的污染00:01:59.720 --> 00:02:02.500比如说我们城市当中的工业排放啊00:02:02.600 --> 00:02:04.320汽车汽车尾气啊00:02:04.320 --> 00:02:06.160都会导致空气质量的下降00:02:06.160 --> 00:02:07.820PM2.5的上升00:02:08.000 --> 00:02:08.320那么00:02:08.320 --> 00:02:11.000长期吸入这些有害的物质的话呢00:02:11.000 --> 00:02:12.860也会增加肺癌的风险00:02:13.000 --> 00:02:16.020那么前面说的还有像二手烟的包啊00:02:16.200 --> 00:02:17.920像长期处于环境当中00:02:17.920 --> 00:02:19.760二手烟的这种环境里面00:02:19.760 --> 00:02:21.780也会增加肺癌的发病率00:02:22.120 --> 00:02:25.500还有一些像室内的空装修的污染00:02:25.800 --> 00:02:28.120说装修环境当中的甲醛啊00:02:28.120 --> 00:02:30.640苯啊这样的一些挥发性的00:02:30.640 --> 00:02:32.200有机的化合物呢00:02:32.200 --> 00:02:34.880可以导致室内的空气质量恶化00:02:34.880 --> 00:02:37.380增加肺癌的可能性啊00:02:39.040 --> 00:02:40.680那么除了这种环境的影响00:02:40.680 --> 00:02:42.520还有吸烟的影响以外呢00:02:42.520 --> 00:02:44.760遗传因素在肺癌的发病当中00:02:44.760 --> 00:02:46.580也起了非常重要的作用00:02:46.680 --> 00:02:48.400呃我们现在都说肺癌呢00:02:48.400 --> 00:02:50.580它具有一定的家族史00:02:50.640 --> 00:02:52.400像有肺癌家族史的人群00:02:52.400 --> 00:02:53.980尤其是这种胰腺00:02:54.280 --> 00:02:55.080呃00:02:55.720 --> 00:02:58.200就是这一级的情愫00:02:58.200 --> 00:02:59.720或者是在家里面00:02:59.720 --> 00:03:01.780有这种早发肺癌的00:03:01.920 --> 00:03:03.400这样家族史的人呢00:03:03.400 --> 00:03:06.400他的尤其是小于45岁就得肺癌00:03:06.400 --> 00:03:08.480直系亲属的这样的一个情况的话00:03:08.480 --> 00:03:11.320那么他得肺癌的这个风险呢00:03:11.320 --> 00:03:12.980要比普通人要高00:03:13.320 --> 00:03:15.720这说明遗传易感性也是呃00:03:15.720 --> 00:03:17.980得肺癌的潜在因素之一00:03:18.160 --> 00:03:18.960包括啊00:03:18.960 --> 00:03:22.180像肺癌会存在基因突变的情况00:03:22.200 --> 00:03:25.440尤其像我们亚洲女性肺腺癌00:03:25.440 --> 00:03:27.800有50%-60%的人群00:03:27.800 --> 00:03:30.360它可能会发生EGFY的一些基因突变00:03:30.360 --> 00:03:31.040还有一些人00:03:31.040 --> 00:03:33.240可能会有ALK基因的突变00:03:33.240 --> 00:03:34.840那这样的一些基因突变呢00:03:34.840 --> 00:03:37.440都会增加个体得肺癌的风险00:03:37.440 --> 00:03:38.080那这些突变00:03:38.080 --> 00:03:40.380有的时候也可以遗传给后代00:03:42.880 --> 00:03:44.080那么接下来我们看一下00:03:44.080 --> 00:03:45.080肺癌的一个早期00:03:45.080 --> 00:03:46.380的症状有哪些00:03:46.640 --> 00:03:48.720肺癌早期的症状的话啊00:03:48.720 --> 00:03:51.140常见的比如说有声音嘶哑00:03:51.560 --> 00:03:54.600嗯如果说这个患者就是声音00:03:54.600 --> 00:03:56.140持续的声音嘶哑00:03:56.160 --> 00:03:57.700而且没有什么原因00:03:57.720 --> 00:03:59.580突然一下出现了声音嘶哑00:03:59.640 --> 00:04:01.120持续的不缓解00:04:01.120 --> 00:04:04.040那么这个时候我们需要去警惕00:04:04.040 --> 00:04:07.000可能是肺癌压迫了喉返神经所致00:04:07.000 --> 00:04:08.520因为像我们有些啊00:04:08.520 --> 00:04:10.400这种背上钩的肿瘤00:04:10.400 --> 00:04:12.400它长在很靠上面的地方00:04:12.400 --> 00:04:14.000就可能会压迫到呃00:04:14.000 --> 00:04:16.180这个喉返神经的走形00:04:16.280 --> 00:04:18.160那么喉返神经被压迫以后00:04:18.160 --> 00:04:19.900就会导致声带的麻痹00:04:19.960 --> 00:04:21.620出现声音嘶哑00:04:22.480 --> 00:04:23.480那么还有一些人00:04:23.480 --> 00:04:26.240会出现持续性的咳嗽啊00:04:26.240 --> 00:04:28.880比如说肿瘤累积到了大气道00:04:28.880 --> 00:04:29.880刺激气道00:04:29.880 --> 00:04:33.480那么就会产产生这个没有原因的00:04:33.480 --> 00:04:34.400也没有发烧00:04:34.400 --> 00:04:35.200也没有感冒00:04:35.200 --> 00:04:36.620就突然一下咳嗽了00:04:36.800 --> 00:04:37.760尤其是这种咳嗽00:04:37.760 --> 00:04:39.620一般是刺激性的干咳00:04:39.800 --> 00:04:42.900它可能也是肺癌的一个信号之一啊00:04:42.960 --> 00:04:45.700那么还有一些不明原因的体重下降00:04:45.720 --> 00:04:47.720尤其是没有刻意的去节食00:04:47.720 --> 00:04:50.040或者增加运动的情况下呃00:04:50.040 --> 00:04:51.360就出现了体重下降00:04:51.360 --> 00:04:54.460有可能是肺癌的一个早期的表现00:04:54.720 --> 00:04:55.600那么还有一些人00:04:55.600 --> 00:04:58.300会出现胸痛或者呼吸困难00:04:58.400 --> 00:05:00.120但出现胸痛或者呼吸困难00:05:00.120 --> 00:05:01.400一般都已经说明00:05:01.400 --> 00:05:04.120肿瘤可能已经出现了并发症00:05:04.120 --> 00:05:07.240或者累积了胸膜或者骨头嗯00:05:07.240 --> 00:05:09.880或者是产生了胸腔积液嗯00:05:09.880 --> 00:05:10.880出现了肺部张00:05:10.880 --> 00:05:12.300这样的一些情况00:05:12.360 --> 00:05:15.060那么才会出现胸痛或者是呼吸困难00:05:15.160 --> 00:05:16.160那么还有一些人00:05:16.160 --> 00:05:17.160可能会表现为00:05:17.160 --> 00:05:19.600反复发作的局部的肺炎00:05:19.600 --> 00:05:21.020或者是支气管炎00:05:21.080 --> 00:05:23.880这主要也是跟肿瘤长在局部00:05:23.880 --> 00:05:25.920然后阻塞啊00:05:25.920 --> 00:05:27.560那么远端的气道呢00:05:27.560 --> 00:05:29.260就是引流不通畅00:05:29.320 --> 00:05:30.000这个时候呢00:05:30.000 --> 00:05:30.920就可能会出00:05:30.920 --> 00:05:34.200现啊远端的一些肺炎啊00:05:34.200 --> 00:05:35.300肺部的炎症00:05:35.520 --> 00:05:36.920那么并且这样的情况下00:05:36.920 --> 00:05:38.640他用普通的抗生素抗感染00:05:38.640 --> 00:05:40.260治疗效果是不好的00:05:40.520 --> 00:05:41.040嗯所以00:05:41.040 --> 00:05:42.480如果是针对这种反复00:05:42.480 --> 00:05:43.560同一部位发肺炎00:05:43.560 --> 00:05:45.880并且抗感染效果不好的情况下00:05:45.880 --> 00:05:47.480那我们要高度警惕00:05:47.480 --> 00:05:49.780这个人是不是个阻塞性的炎症00:05:51.760 --> 00:05:53.880那么肺癌的这些症状00:05:53.880 --> 00:05:55.640跟普通的疾病的症状呢00:05:55.640 --> 00:05:57.460还会有一些小的区别00:05:57.600 --> 00:05:59.940第一个首先在咳嗽方面00:06:00.200 --> 00:06:01.840肺癌他的早期表现00:06:01.840 --> 00:06:02.720他的咳嗽呢00:06:02.720 --> 00:06:05.800基本上是一个持续性的咳嗽呃00:06:05.800 --> 00:06:07.200并且没有什么诱因00:06:07.200 --> 00:06:08.640突然一下就咳嗽了00:06:08.640 --> 00:06:10.360那么这跟感冒引起的咳嗽00:06:10.360 --> 00:06:11.360就不太一样00:06:11.360 --> 00:06:12.680我们感冒引起的咳嗽00:06:12.680 --> 00:06:13.880常常是受凉以后00:06:13.880 --> 00:06:15.100可能会有发热00:06:15.280 --> 00:06:16.360咳脓痰鼻塞00:06:16.360 --> 00:06:19.020流鼻涕四肢酸痛这样的一些表现00:06:19.240 --> 00:06:21.020那么后续出现了咳嗽00:06:21.080 --> 00:06:23.380那么随着他的这个感染的控制00:06:23.400 --> 00:06:26.020咳嗽慢慢的也会缓解和恢复00:06:26.440 --> 00:06:27.520并且持续的时间呢00:06:27.520 --> 00:06:28.540不会很久00:06:28.560 --> 00:06:30.320所以如果说一个一个人00:06:30.320 --> 00:06:32.500他持续性的不明原因的干咳00:06:33.160 --> 00:06:34.520时间超过一个月00:06:34.520 --> 00:06:35.000两个月00:06:35.000 --> 00:06:37.220那么我们还是建议做个胸部CT00:06:37.360 --> 00:06:39.860排除一下肺部的疾病啊00:06:40.280 --> 00:06:41.160那么第二个00:06:41.160 --> 00:06:42.120像呼吸困难00:06:42.120 --> 00:06:43.920肺癌引起的呼吸困难呃00:06:43.920 --> 00:06:46.120他跟其他的疾病引起的呼吸困难00:06:46.120 --> 00:06:47.660也会有一些区别00:06:47.880 --> 00:06:49.920嗯尤其可能啊00:06:49.920 --> 00:06:51.600他出现的呼吸困难呢00:06:51.600 --> 00:06:54.360意味着肺癌已经引起了一些并发症00:06:54.360 --> 00:06:56.080嘛胸水啊00:06:56.080 --> 00:06:57.420胸腔积液啊00:06:58.040 --> 00:06:59.160或者是肺不张啊00:06:59.160 --> 00:06:59.880这样子00:06:59.880 --> 00:07:02.880那么他的呼吸困难会没有处理的话00:07:02.880 --> 00:07:04.000会越来越严重00:07:04.000 --> 00:07:05.260进行性的加重00:07:05.360 --> 00:07:07.800尤其在体力活动以后可能会加重00:07:07.800 --> 00:07:10.640那么跟一些我们像支气管哮喘00:07:10.640 --> 00:07:12.020这样的一些疾病呢00:07:12.120 --> 00:07:14.200会有区别支气管哮喘的话00:07:14.200 --> 00:07:16.120他在急性发的时候会起急00:07:16.120 --> 00:07:17.280但是在缓解期呢00:07:17.280 --> 00:07:18.980他的症状又可以缓解00:07:20.720 --> 00:07:21.480声音嘶哑呢00:07:21.480 --> 00:07:23.820跟普通的声音嘶哑也不一样00:07:23.880 --> 00:07:24.740这里面00:07:25.040 --> 00:07:25.960比如说啊00:07:25.960 --> 00:07:28.040就是我们急性的喉炎啊00:07:28.040 --> 00:07:29.740可能会出现声音嘶哑00:07:29.760 --> 00:07:32.700当然他常常会有一些感染的诱因00:07:32.760 --> 00:07:34.540和他的临床表现00:07:34.840 --> 00:07:35.760咽喉肿痛啊00:07:35.760 --> 00:07:37.480讲的一些发热00:07:37.480 --> 00:07:39.800那么基本上急性期过了00:07:39.800 --> 00:07:41.640他的神经嘶哑会缓解的00:07:41.640 --> 00:07:43.280那肺癌的神经嘶哑呢00:07:43.280 --> 00:07:46.520因为考虑是这种肿瘤压迫引起的00:07:46.520 --> 00:07:46.880那么00:07:46.880 --> 00:07:49.760基本上是不太会随着时间的推移00:07:49.760 --> 00:07:51.580去缓解啊00:07:51.920 --> 00:07:54.220所以说持续的声音嘶哑也要警惕00:07:54.480 --> 00:07:55.400嗯当然了00:07:55.400 --> 00:07:58.760我们临床上更常见的就是早期肺癌00:07:58.760 --> 00:08:01.440它是完全可以没有任何症状00:08:01.440 --> 00:08:02.280因为肺呢00:08:02.280 --> 00:08:04.040它不是一个呃00:08:04.040 --> 00:08:07.280神经分布很密切的一个组织啊00:08:07.280 --> 00:08:09.040他长一个肿瘤的话00:08:09.040 --> 00:08:11.120常常是感觉不到的啊00:08:11.120 --> 00:08:12.820肺的本身的容积也很大00:08:12.840 --> 00:08:14.480长一个3公分的肿瘤00:08:14.480 --> 00:08:15.560孤立性的结节00:08:15.560 --> 00:08:17.540他完全可以没有任何症状00:08:17.680 --> 00:08:20.300嗯甚至一些晚期的肺癌00:08:20.440 --> 00:08:22.040他只要没有累积到大气道00:08:22.040 --> 00:08:23.680没有累积到气嗯00:08:23.680 --> 00:08:25.420胸膜没有累积到肋骨00:08:25.640 --> 00:08:27.560也没有出现大量的胸腔积液00:08:27.560 --> 00:08:28.360肺不张00:08:28.400 --> 00:08:30.900他完全可以没有任何的症状00:08:31.160 --> 00:08:32.380所以我们00:08:33.840 --> 00:08:35.560呃去筛查肿瘤的话00:08:35.560 --> 00:08:37.460会判断一个人是否有得肺癌00:08:37.520 --> 00:08:39.440不能根据他的症状来判断00:08:39.440 --> 00:08:41.980也不能根据症状来判断他的严重性00:08:42.120 --> 00:08:44.660而是需要做体检筛查00:08:44.680 --> 00:08:47.060这样才能发现一些早期的病灶00:08:48.760 --> 00:08:49.760这里面就说明00:08:49.760 --> 00:08:52.560我们定期体检非常非常的重要了00:08:52.560 --> 00:08:54.280因为我们早肺癌的话00:08:54.280 --> 00:08:55.320早期发现它00:08:55.320 --> 00:08:57.400有的时候就是个孤立性的一个结节00:08:57.400 --> 00:09:00.200那么这个时候你把它手术切除也00:09:00.200 --> 00:09:01.180就根治了00:09:01.320 --> 00:09:02.800大部分人也就不会复发00:09:02.800 --> 00:09:03.920尤其现在我们体检00:09:03.920 --> 00:09:06.080发现了很多种毛玻璃结节00:09:06.080 --> 00:09:07.840很多都是一些原位癌啊00:09:07.840 --> 00:09:09.000微浸润癌啊00:09:09.000 --> 00:09:10.360或者是分化比较好的00:09:10.360 --> 00:09:11.820一个早期浸润型癌00:09:12.080 --> 00:09:13.640呃也没有什么高危因素00:09:13.640 --> 00:09:16.060这种呢他做了一个切除以后00:09:16.120 --> 00:09:17.560他的愈合非常好00:09:17.560 --> 00:09:19.000基本上不会复发00:09:19.000 --> 00:09:21.020也不需要术后的辅助治疗00:09:21.080 --> 00:09:23.380只需要规律的随访就可以了00:09:23.440 --> 00:09:25.640但是如果让他任由他发展00:09:25.640 --> 00:09:27.620发展到了晚期00:09:27.720 --> 00:09:29.260呃肿瘤很大00:09:29.680 --> 00:09:31.400出现了各种各样的并发症00:09:31.400 --> 00:09:33.220以及出现了转移00:09:33.240 --> 00:09:34.000那么这个时候00:09:34.000 --> 00:09:36.540没办法通过手术去根治了00:09:36.560 --> 00:09:39.220只能通过我们内科的一些治疗方式00:09:39.480 --> 00:09:40.960去呃控制疾病00:09:40.960 --> 00:09:42.920延长生存期00:09:42.920 --> 00:09:45.020延缓病情的疾病的进展00:09:45.120 --> 00:09:46.600改善他的生活质量00:09:46.600 --> 00:09:47.640这个时候00:09:47.640 --> 00:09:50.320我们就涉及到很多很多的一些检查00:09:50.320 --> 00:09:52.640你首先要去穿刺啊00:09:52.640 --> 00:09:53.520气管镜啊00:09:53.520 --> 00:09:54.660明确病理00:09:54.920 --> 00:09:56.020然后分型00:09:56.120 --> 00:09:58.500然后做Pad CT全身评估00:09:58.600 --> 00:10:01.000然后还要去做基因检测00:10:01.000 --> 00:10:02.500PDI one的检测00:10:02.520 --> 00:10:05.660做一个个体化的一个表情的判断00:10:05.720 --> 00:10:08.320然后再给他一个相应的特异00:10:08.320 --> 00:10:09.640相应的一个治疗00:10:09.640 --> 00:10:11.040有些人吃靶向药00:10:11.040 --> 00:10:11.920有些人化疗00:10:11.920 --> 00:10:13.700免疫长期维持治疗00:10:14.040 --> 00:10:16.480这就涉及到很多的很多的00:10:16.480 --> 00:10:18.380这个经济的负担00:10:18.440 --> 00:10:20.000以及对患者来说呢00:10:20.000 --> 00:10:22.180他也是一个非常长期的呵护00:10:22.280 --> 00:10:24.060比较痛苦的一个过程00:10:24.320 --> 00:10:25.400所以说呃00:10:25.400 --> 00:10:28.440我们需要去鼓励患者00:10:28.440 --> 00:10:30.080进行一个体格检00:10:30.080 --> 00:10:33.840就是作为把我们的一些肺部的检查00:10:33.840 --> 00:10:36.500作为一个常规的一个体检的项目00:10:36.560 --> 00:10:37.780定期体检00:10:37.840 --> 00:10:39.340早期发现疾病00:10:39.400 --> 00:10:40.120那么所以说00:10:40.120 --> 00:10:42.860这个定期体检就非常非常的重要了00:10:43.280 --> 00:10:45.320那么我们应该通过什么样的检00:10:45.320 --> 00:10:46.440检查的手段来00:10:46.440 --> 00:10:47.720发现肿瘤呢00:10:47.720 --> 00:10:50.640他肿瘤肺癌的话有哪些诊断的方式00:10:50.640 --> 00:10:52.060我们来具体看一下00:10:52.360 --> 00:10:53.520首先非常重要的一个00:10:53.520 --> 00:10:55.580就是影像学的检查00:10:55.680 --> 00:10:57.280影像学检查当中00:10:57.280 --> 00:10:59.820第一个像我们的胸片00:10:59.880 --> 00:11:01.360它是筛查肺癌的00:11:01.360 --> 00:11:03.500一个非常常见的方式啊00:11:03.600 --> 00:11:06.060嗯以前我们用的很多00:11:06.280 --> 00:11:07.040嗯但是呢00:11:07.040 --> 00:11:10.240因为胸片它是一个呃定位片00:11:10.240 --> 00:11:13.540它就是把前后我们的整个胸腔00:11:13.560 --> 00:11:16.100它压缩成一张片子成像00:11:16.200 --> 00:11:18.120那么这也就会嗯00:11:18.120 --> 00:11:19.920导致它的分辨率比较低00:11:19.920 --> 00:11:22.540一些小病灶呢就是剪不出来00:11:22.640 --> 00:11:25.860包括一些在心脏后面膈肌后面00:11:25.920 --> 00:11:27.920骨头后面被挡住的地方00:11:27.920 --> 00:11:29.700它就没办法发现00:11:29.800 --> 00:11:31.360嗯所以一般呢00:11:31.360 --> 00:11:33.840胸片用来做在早期的肿瘤筛查呢00:11:33.840 --> 00:11:35.100就不太够啊00:11:35.520 --> 00:11:37.360那么所以我们现在更过00:11:37.360 --> 00:11:40.120包括国际上更加推荐用啊00:11:40.120 --> 00:11:42.420低剂量的CT进行00:11:42.600 --> 00:11:46.140嗯作为一个我们肺部的一个呃00:11:47.000 --> 00:11:48.320肿瘤的一个筛查00:11:48.320 --> 00:11:51.400因为CT的话呢是它就像切西瓜一样00:11:51.400 --> 00:11:54.420把我们的整个肺一层一层切下来00:11:54.440 --> 00:11:55.280呃我们的薄层00:11:55.280 --> 00:11:58.120CT的话可以切成一毫米一个层厚的00:11:58.120 --> 00:11:59.500然后单独成像00:11:59.840 --> 00:12:00.600这样的话呢00:12:00.600 --> 00:12:03.740他就不会去有遮挡的问题00:12:03.840 --> 00:12:05.420而且分辨率非常高00:12:05.440 --> 00:12:08.440可以对肺部的一些非常微小的病灶00:12:08.440 --> 00:12:11.4205毫米以下的结节都可以被发现啊00:12:11.880 --> 00:12:13.440哎这也是我们常规的00:12:13.440 --> 00:12:16.900现在用作呃c用作筛查的一个手段00:12:16.920 --> 00:12:19.180那么还有一些像Pad CT00:12:19.320 --> 00:12:22.480Pad CT就是正电子发射断层扫描00:12:22.480 --> 00:12:23.920它是一个全身的CT00:12:23.920 --> 00:12:27.380结合了呃这些对于呃病灶的00:12:27.720 --> 00:12:29.920嗯代谢进行综合判断00:12:29.920 --> 00:12:31.760来判断这个肿瘤00:12:31.760 --> 00:12:34.100这个病灶是良性还是恶性00:12:34.120 --> 00:12:35.880包括如果是恶性肿瘤的话00:12:35.880 --> 00:12:36.400我们可以通00:12:36.400 --> 00:12:39.040过pet CT做一个全身的评估00:12:39.040 --> 00:12:41.340看有没有转移灶啊00:12:41.520 --> 00:12:44.080那么当然它不是我们作为体检00:12:44.080 --> 00:12:46.640作为筛查肿瘤的一个常规手段00:12:46.640 --> 00:12:49.560一般用于在判断这个病灶良恶性00:12:49.560 --> 00:12:51.640较困难或者是要评估00:12:51.640 --> 00:12:53.720这个肿瘤的分期的时候00:12:53.720 --> 00:12:54.980再去使用00:12:56.000 --> 00:12:58.720还有一些生物标记物的检测啊00:12:58.720 --> 00:13:01.140包括像血的肿瘤标记物啊00:13:01.160 --> 00:13:03.260还有痰的细胞血的检测00:13:03.320 --> 00:13:05.740还有液体细胞的一些检测00:13:06.160 --> 00:13:10.020这些呢是我们作为影像的一个补充00:13:10.080 --> 00:13:12.400作为一个辅助检查的一个手段00:13:12.400 --> 00:13:13.640包括像肿瘤标记物00:13:13.640 --> 00:13:14.680还可以作为一个00:13:14.680 --> 00:13:16.440病情的预后的一个判断00:13:16.440 --> 00:13:20.180和动态监测治疗效果的一个指标啊00:13:21.160 --> 00:13:23.200当然肺癌的确诊的话呢00:13:23.200 --> 00:13:25.160还是要根据病理00:13:25.160 --> 00:13:27.220名叫组织病理学的确诊00:13:27.440 --> 00:13:29.720呃也就说我们一个人呃00:13:29.720 --> 00:13:33.340去肿瘤CT发现了肺上面有一个肿块00:13:33.360 --> 00:13:35.340那么高度怀疑他是恶性肿瘤00:13:35.600 --> 00:13:38.100但是影像的判断只是影像学00:13:38.240 --> 00:13:40.620因为我们有很多人是同病异影00:13:40.640 --> 00:13:42.040异病同病这样的00:13:42.040 --> 00:13:43.160一样的影像00:13:43.160 --> 00:13:44.840一样的影像学00:13:44.840 --> 00:13:47.240所以我们不能根据影像学来说00:13:47.240 --> 00:13:49.620这个肯定100%就是恶性肿瘤00:13:49.640 --> 00:13:50.920怎么才能确诊呢00:13:50.920 --> 00:13:52.280一定要在这个上面00:13:52.280 --> 00:13:54.000去取一点组织下来00:13:54.000 --> 00:13:55.560拿到做病理切片00:13:55.560 --> 00:13:57.620然后拿到显微镜下去分析00:13:57.880 --> 00:14:00.440看到癌细胞癌癌的组织00:14:00.440 --> 00:14:02.480那么才能够去确诊和00:14:02.480 --> 00:14:03.360并且去分出00:14:03.360 --> 00:14:05.620它具体是哪一个类型的恶性肿瘤00:14:07.400 --> 00:14:09.160那么我们组织的确诊呢00:14:09.160 --> 00:14:10.080有几种方式00:14:10.080 --> 00:14:11.760取病理的方式有几种00:14:11.760 --> 00:14:14.200第一个可以做气管镜的检查00:14:14.200 --> 00:14:17.680我们通过气管镜从鼻腔或者口腔啊00:14:17.680 --> 00:14:19.880一根镜子到达我们的肺部00:14:19.880 --> 00:14:21.740然后去取病灶00:14:22.200 --> 00:14:24.080如果能这个病灶就长在腔内的00:14:24.080 --> 00:14:25.320话我们能看到的话00:14:25.320 --> 00:14:28.560可以在直视下就去做活检啊00:14:28.560 --> 00:14:30.240然后活检前取点组织下来00:14:30.240 --> 00:14:31.520还可以通过刷检啊00:14:31.520 --> 00:14:34.120各方面的各种手段去去组织00:14:34.120 --> 00:14:35.780然后拿去做病理切片00:14:35.920 --> 00:14:37.280如果说肿瘤长在外周00:14:37.280 --> 00:14:38.560我们腔内看不到00:14:38.560 --> 00:14:40.320还可以结合外周超声00:14:40.320 --> 00:14:42.260气管镜和x线定位00:14:42.280 --> 00:14:44.440然后去透视下00:14:44.440 --> 00:14:47.080把这个嗯组织到达00:14:47.080 --> 00:14:47.880这个组织的部位00:14:47.880 --> 00:14:48.880去取病理00:14:48.880 --> 00:14:50.280包括一些淋巴结00:14:50.280 --> 00:14:51.640我们还可以通过超声00:14:51.640 --> 00:14:54.040气管径去探及呃00:14:54.040 --> 00:14:57.220淋巴结然后再做珍稀活检啊00:14:57.600 --> 00:15:00.320那么还有除了气管镜以下以外呢00:15:00.320 --> 00:15:03.600像一些在靠近外周的呃肿块的话00:15:03.600 --> 00:15:05.120我们可以通过啊00:15:05.120 --> 00:15:08.400像b超或者是CT引导之下00:15:08.400 --> 00:15:09.520定位了以后00:15:09.520 --> 00:15:10.800从胸壁穿针00:15:10.800 --> 00:15:14.000到达这个肺部组肿瘤的组织的地方00:15:14.000 --> 00:15:16.220然后去取一点呃00:15:16.720 --> 00:15:17.560这个肿块上面00:15:17.560 --> 00:15:19.440取个一条两条组织下来00:15:19.440 --> 00:15:21.060拿去做病理的切片00:15:22.480 --> 00:15:24.880那么还有一些比如说这个人00:15:24.880 --> 00:15:27.940他这个肿块高度怀疑是肿瘤的00:15:28.200 --> 00:15:30.280形态学上基本上判断就是的00:15:30.280 --> 00:15:33.120可以直接把他手术切掉00:15:33.120 --> 00:15:34.080也有一些或者呢00:15:34.080 --> 00:15:37.020就是他通过气管镜或者是CT00:15:37.160 --> 00:15:39.620这种定位下去做穿刺00:15:39.640 --> 00:15:42.280都非常难取到肿瘤去00:15:42.280 --> 00:15:43.160那么这个时候00:15:43.160 --> 00:15:46.080我们也可以考虑直接去做手术00:15:46.080 --> 00:15:48.280去把整个肿块去切除下来00:15:48.280 --> 00:15:51.920然后再去呃做一个病理的检测00:15:51.920 --> 00:15:54.440那么当然他因为是完整的切除00:15:54.440 --> 00:15:55.480那么他的结果呢00:15:55.480 --> 00:15:56.940也会更加准确00:16:00.400 --> 00:16:01.400那接下来我们看一下00:16:01.400 --> 00:16:03.100肺癌的一些治疗的手段00:16:03.160 --> 00:16:04.560肺癌的治疗的话啊00:16:04.560 --> 00:16:07.440早期的我们根治肺癌的手段00:16:07.440 --> 00:16:08.820就是手术治疗00:16:09.080 --> 00:16:10.380手术切除00:16:10.440 --> 00:16:11.300嗯00:16:11.400 --> 00:16:13.760那么这里面我们根据结节的大小00:16:13.760 --> 00:16:15.900分期部位啊00:16:16.560 --> 00:16:17.680那么来判断他到00:16:17.680 --> 00:16:19.760底是做一个肺叶切除就可以00:16:19.760 --> 00:16:21.880还是做要做全肺的切除00:16:21.880 --> 00:16:25.520还是通过我们做一个局部的切切00:16:25.520 --> 00:16:26.800或者是肺断的切除00:16:26.800 --> 00:16:29.240就可以把肿瘤完全性的切除00:16:29.240 --> 00:16:31.660这个呢就是要综合判断的啊00:16:32.840 --> 00:16:34.460那么除了手术以外00:16:34.520 --> 00:16:35.840手术切除以外00:16:35.840 --> 00:16:38.280那我们像一些1B期的手术00:16:38.280 --> 00:16:41.360早期的肿瘤术后他有高危因素的00:16:41.360 --> 00:16:42.040或者二期00:16:42.040 --> 00:16:43.600三期等00:16:43.600 --> 00:16:44.720术后的患者00:16:44.720 --> 00:16:47.400我们是需要做一个辅助性的治疗00:16:47.400 --> 00:16:49.360内科治疗去降低复发的00:16:49.360 --> 00:16:51.000还有一些晚期肿瘤的病人00:16:51.000 --> 00:16:53.240他本身就没办法去手术了00:16:53.240 --> 00:16:55.940那么需要去做我们的内科的治疗00:16:56.160 --> 00:16:58.920还有一些呃晚期局部晚期的肿瘤00:16:58.920 --> 00:17:00.360可以在手术之前00:17:00.360 --> 00:17:02.360我们先做内科的一些化疗00:17:02.360 --> 00:17:02.920免疫治疗00:17:02.920 --> 00:17:04.160叫做新辅助00:17:04.160 --> 00:17:06.780把肿瘤缩小以后再去手术00:17:06.800 --> 00:17:08.580术后再做辅助治疗00:17:08.720 --> 00:17:10.360那么内科治疗的方式呢00:17:10.360 --> 00:17:12.380就包括像化疗00:17:12.440 --> 00:17:14.260还有靶向药的治疗00:17:14.600 --> 00:17:15.400放疗00:17:15.440 --> 00:17:18.160还有像一些免疫的治疗啊00:17:18.160 --> 00:17:19.400那么现在呢00:17:19.400 --> 00:17:21.240真选择哪种治疗方案呢00:17:21.240 --> 00:17:25.019我们现在都是要个体化的治疗00:17:25.119 --> 00:17:26.479需要去啊00:17:26.479 --> 00:17:27.599根据这个人00:17:27.599 --> 00:17:30.120他一个肿瘤是哪一个类型00:17:30.120 --> 00:17:33.160比如说是小细胞还是非小细胞肺癌00:17:33.160 --> 00:17:36.280那么他的分期是一期二期00:17:36.280 --> 00:17:37.900还是三期四期00:17:38.200 --> 00:17:39.780要进行一个详细的分析00:17:39.840 --> 00:17:43.360然后还要去检测肺癌的分子特性00:17:43.360 --> 00:17:45.860比如说它有没有基因突变00:17:46.040 --> 00:17:48.380是哪一个类型的基因突变00:17:48.680 --> 00:17:51.100然后有没有PDR one的高表达00:17:51.280 --> 00:17:54.520然后去获得他的详细信息00:17:54.520 --> 00:17:55.240以后00:17:55.240 --> 00:17:58.380再针对他个人的患者的一般情况00:17:58.440 --> 00:18:01.040比如说他的生活质量怎么样啊00:18:01.040 --> 00:18:02.240年龄怎么样00:18:02.240 --> 00:18:04.780再去制定个体化的一个治疗方案00:18:04.960 --> 00:18:07.480是选择靶向药物治疗比较合适呢00:18:07.480 --> 00:18:08.760还是化疗呢00:18:08.760 --> 00:18:11.000还是要做放疗啊00:18:11.000 --> 00:18:12.520那么总体来说呢00:18:12.520 --> 00:18:16.480是早期患者尽量去做到治愈00:18:16.480 --> 00:18:19.400那么晚期的局部晚期的患者00:18:19.400 --> 00:18:22.960要去提高他的生存质量00:18:22.960 --> 00:18:25.780然后延长他的生存期啊00:18:28.440 --> 00:18:29.080那接下来00:18:29.080 --> 00:18:31.600我们再说一下肺癌的预防措施00:18:31.600 --> 00:18:32.600肺癌的预防的话00:18:32.600 --> 00:18:35.060首先第一个戒烟非常重要00:18:35.440 --> 00:18:37.760戒烟的话我们可以降低肺癌的风险00:18:37.760 --> 00:18:40.260同样也可以改善心肺的功能00:18:40.360 --> 00:18:41.560还可以减少00:18:41.560 --> 00:18:43.080除了对自己的影响以外00:18:43.080 --> 00:18:46.440还可以减少对别人的二手烟的危害00:18:46.440 --> 00:18:49.180保护了家人和周周围的人啊00:18:49.240 --> 00:18:51.140那么还有就是00:18:51.600 --> 00:18:53.360保持健康的生活方式00:18:53.360 --> 00:18:55.000均衡饮食啊啊00:18:55.000 --> 00:18:55.680定期体检00:18:55.680 --> 00:18:56.960适度活动啊00:18:56.960 --> 00:18:58.580运动避免二手烟00:18:58.600 --> 00:19:00.480这样的一些健康生活方式呢00:19:00.480 --> 00:19:02.060也可以预防疾病00:19:02.440 --> 00:19:04.440当然其中最重要的一点就是00:19:04.440 --> 00:19:06.440我们需要对于高危人群00:19:06.440 --> 00:19:08.940进行一个定期的健康筛查00:19:09.040 --> 00:19:10.240比如说呃00:19:10.240 --> 00:19:12.920这里家里有这个早发肺癌病史的00:19:12.920 --> 00:19:14.700有长期吸烟史的00:19:14.760 --> 00:19:16.880嗯本身是有慢阻肺象的00:19:16.880 --> 00:19:17.920一些疾病病史的00:19:17.920 --> 00:19:20.100年龄啊大于600:19:20.280 --> 00:19:21.520大于45岁以上00:19:21.520 --> 00:19:23.600或者50岁以上的老年人群00:19:23.600 --> 00:19:26.640那我们需要去定期做一个低剂量的00:19:26.640 --> 00:19:28.260螺旋CT的筛查00:19:31.760 --> 00:19:33.280那么接下来00:19:33.280 --> 00:19:35.820我们再讲一下肺癌的康复和支持00:19:36.160 --> 00:19:37.400肺癌的康复的话呢00:19:37.400 --> 00:19:40.420主要是针对一些呃诊确诊的肺癌00:19:40.440 --> 00:19:42.160然后进行治疗的00:19:42.160 --> 00:19:43.520呃要么是手术后的00:19:43.520 --> 00:19:44.740要么是这种00:19:44.760 --> 00:19:45.560呃00:19:45.720 --> 00:19:48.240免疫治疗或者化疗之后的一些患者00:19:48.240 --> 00:19:50.900首先我们必须要的是定期复查00:19:50.920 --> 00:19:53.260我们要定期都监控的病情00:19:53.280 --> 00:19:54.580那接下来呢00:19:54.600 --> 00:19:55.720呃这些患者呢00:19:55.720 --> 00:19:57.860要给他一个营养的支持00:19:57.880 --> 00:20:00.340提供均衡的一个饮食00:20:00.560 --> 00:20:01.560高蛋白的食物00:20:01.560 --> 00:20:03.840让他获得一个足够的营养和00:20:03.840 --> 00:20:05.240支持身体的恢复00:20:05.240 --> 00:20:06.380还有戒烟00:20:06.600 --> 00:20:09.340包括还要给他进行一个心理的辅导00:20:09.800 --> 00:20:11.480嗯那么心理的知识和辅导呢00:20:11.480 --> 00:20:12.720我们可以呃00:20:12.720 --> 00:20:15.180去建立一些患者的知识小组00:20:15.480 --> 00:20:18.140那么让病友之间可以分享经验00:20:18.200 --> 00:20:18.960互相鼓励00:20:18.960 --> 00:20:20.360减轻压力啊00:20:20.360 --> 00:20:22.920也可以去提供一些专业的心理咨询00:20:22.920 --> 00:20:24.720去给他处理一些焦虑00:20:24.720 --> 00:20:26.480抑郁这样的一些情绪问题00:20:26.480 --> 00:20:27.900提高生活质量00:20:28.000 --> 00:20:29.480那么还可以啊00:20:29.480 --> 00:20:31.640需要对肺癌患者的家庭成员00:20:31.640 --> 00:20:33.400也要进行一个心理的辅导00:20:33.400 --> 00:20:36.320让他们去能够更好的支持患者00:20:36.320 --> 00:20:38.620同时也照顾他们的一个情绪00:20:39.360 --> 00:20:39.840好00:20:39.840 --> 00:20:42.040那么今天我的分享就到这里00:20:42.040 --> 00:20:43.020谢谢大家