[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"$f65-g5LTUgHIk8dGZIHhGe2pKpxnfW0g-O4HGxk3yxcs":3,"$fCja0BGgbg_kZpSop-w0SF4fWJc56DC-20E9cUjzqBw4":8,"$ftHGKlgRv_oUydXhen6rzlU2FeqVkdTzTdyJc_MC2GPE":59,"$fg7X9KXou23ngEHwW-WYm0uu0VD3sxWvhVGNlxKQA7Xk":60,"$frl6GsBFdRD3Zn6G8MwKN6qQZ4pgUywStL38HxPo2zTA":64},{"code":4,"msg":5,"message":6,"data":6,"success":7},401,"认证失败，无法访问系统资源",null,false,{"code":9,"msg":10,"message":6,"data":11,"success":58},200,"操作成功",{"id":12,"specialistId":13,"specialistAssistants":14,"profilePhoto":15,"specialistName":16,"roleType":6,"adept":17,"hospital":18,"department":19,"postsTitle":20,"materialTotal":21,"videoTotal":22,"isConcern":7,"title":23,"coverVertical":24,"coverAcross":25,"directionMarker":21,"description":26,"vid":27,"time":28,"mediaType":21,"views":29,"likes":30,"isThumbsUp":7,"isCollection":7,"collections":30,"createTime":31,"seoTitle":32,"seoKeywords":33,"seoDescription":34,"shelvesTime":35,"menus":36,"menuId":38,"type":22,"quality":55,"commentCount":30,"isComment":21,"deviceType":56,"url":57},10755,865093,[],"https://ystcdn.venuertc.com/medical/ystApp/vbDpuFL9tsh14NEQITE82vjVpGvMHqsX.png","施学忠","擅长老年慢性病，慢性疾病管理、皮肤病和过敏反应、消化系统疾病、急性疾病和急救处理等。","上海市徐汇区漕河泾街道社区卫生服务中心","全科医疗","副主任医师",1,2,"肺结节定义与分类","","https://cdn.yishi-tong.com/console/3/q0qZMZkA3wjs9beLssQ8c7Vcq2JEDRsC.png","WEBVTT\n\n00:01.760 --> 00:01.960\n嗯，\n\n00:02.009 --> 00:02.859\n肺结节呢，\n\n00:02.859 --> 00:05.135\n是主要是肺影像学呢，\n\n00:05.135 --> 00:11.310\n是表现为直径小于等于3cm的局灶性的类圆形密度增高的实性，\n\n00:11.310 --> 00:13.710\n或者是亚实性的那个肺部阴影。\n\n00:14.500 --> 00:15.574\n可以为孤立性，\n\n00:15.574 --> 00:16.750\n或者是多发性，\n\n00:16.899 --> 00:19.299\n不伴有肺部扎肺门淋巴结肿大，\n\n00:19.299 --> 00:21.500\n以及是胸腔的积液。\n\n00:22.271 --> 00:23.271\n然后肺肿块呢，\n\n00:23.271 --> 00:23.847\n一般性呢，\n\n00:23.847 --> 00:25.322\n是指局部呢，\n\n00:25.371 --> 00:27.972\n病种是大于3cm的。\n\n00:29.156 --> 00:29.582\n分类呢，\n\n00:29.582 --> 00:30.306\n可以看到呢，\n\n00:30.306 --> 00:32.931\n数量孤立性的单个的病灶以及呢，\n\n00:32.931 --> 00:36.056\n是或者是多发性的两个及以上的病灶。\n\n00:36.506 --> 00:37.431\n微小结节呢，\n\n00:37.431 --> 00:40.957\n一般性直直直径是小于5cm，\n\n00:40.957 --> 00:42.032\n而小结节呢，\n\n00:42.032 --> 00:43.657\n一般是5.10cm。\n\n00:43.957 --> 00:44.782\n肺结节呢，\n\n00:44.782 --> 00:49.032\n是直径是10cm到二十十毫米到30mm，\n\n00:49.032 --> 00:50.457\n也就是1.3cm。\n\n00:50.506 --> 00:51.231\n密度呢，\n\n00:51.231 --> 00:56.407\n是实性的结节病变密度足足以覆盖呢，\n\n00:56.407 --> 00:59.356\n其中走形的血管或者是支气管。\n\n00:59.459 --> 01:00.884\n反应亚实性的结节呢，\n\n01:00.884 --> 01:01.709\n是纯毛。\n\n01:03.115 --> 01:05.239\n毛玻璃磨玻璃结结节，\n\n01:05.239 --> 01:06.665\n以及那是PGGN，\n\n01:06.665 --> 01:08.065\n或者是混杂性的，\n\n01:08.114 --> 01:09.464\n或是NGGN。\n\n01:12.475 --> 01:12.700\n嗯，\n\n01:12.700 --> 01:13.250\n这个呢，\n\n01:13.250 --> 01:14.825\n可以看到两两张片子，\n\n01:14.825 --> 01:17.426\n都是一个这边是一个肺部的结节，\n\n01:17.875 --> 01:18.801\n然后这个呢，\n\n01:18.801 --> 01:21.500\n也是一个这边也是一个小结节。\n\n01:21.500 --> 01:22.776\n这些都是散在的。\n\n01:24.111 --> 01:24.512\n然后呢，\n\n01:24.512 --> 01:25.637\n筛查的人群呢，\n\n01:25.637 --> 01:26.037\n以及呢，\n\n01:26.037 --> 01:27.162\n是评估的手段。\n\n01:28.199 --> 01:28.349\n嗯，\n\n01:28.349 --> 01:28.775\n这个呢，\n\n01:28.775 --> 01:29.925\n可以看到我们现在呢，\n\n01:29.925 --> 01:31.599\n是高危的人群筛查。\n\n01:32.344 --> 01:34.668\n一个是年龄大于等于四十岁以上，\n\n01:34.668 --> 01:35.268\n并且呢，\n\n01:35.268 --> 01:38.143\n是具有以下的任何一种危险因素。\n\n01:42.089 --> 01:45.714\n吸烟大于等于二十包每年或者是每年呢，\n\n01:45.714 --> 01:48.440\n是四百四百支以上的，\n\n01:48.940 --> 01:49.339\n嗯，\n\n01:49.690 --> 01:53.290\n或者是曾经吸烟的大于等于二十包，\n\n01:53.790 --> 01:56.889\n或者是年四百支以上的，\n\n01:57.690 --> 01:58.790\n戒烟时间呢，\n\n01:58.790 --> 02:00.239\n是小于15年。\n\n02:01.385 --> 02:01.959\n第二个呢，\n\n02:01.959 --> 02:04.934\n是有环境或者是高危职业的暴露史，\n\n02:05.535 --> 02:05.934\n嗯，\n\n02:05.934 --> 02:07.635\n比如说有石棉啊，\n\n02:08.134 --> 02:09.235\n这种皮呀，\n\n02:09.485 --> 02:10.335\n釉啊，\n\n02:10.684 --> 02:12.460\n氡等，\n\n02:12.460 --> 02:13.285\n这种是。\n\n02:14.813 --> 02:15.388\n粉尘啊，\n\n02:15.388 --> 02:17.162\n或者是放射性的物质啊，\n\n02:17.162 --> 02:18.313\n有接触的病人。\n\n02:19.205 --> 02:19.755\n第三个呢，\n\n02:19.755 --> 02:23.104\n是有合并有慢性阻塞性肺病啊，\n\n02:23.104 --> 02:24.904\n弥漫性肺纤维化啊，\n\n02:25.005 --> 02:27.904\n或者是既往有那种肺结核病啊，\n\n02:27.904 --> 02:30.854\n间质性肺炎这种病史的患者。\n\n02:31.804 --> 02:32.479\n第四呢，\n\n02:32.479 --> 02:34.654\n是既往患有恶性的肿瘤。\n\n02:36.044 --> 02:36.369\n或者呢，\n\n02:36.369 --> 02:41.195\n是家里面家族史里面有这种肺肺癌，\n\n02:41.645 --> 02:42.044\n嗯，\n\n02:42.395 --> 02:47.820\n或者是这种疾病的病家族史这些都是属于高危人群，\n\n02:47.820 --> 02:49.544\n应该是密切的观察。\n\n02:50.294 --> 02:50.645\n嗯，\n\n02:50.645 --> 02:51.845\n评估的结果呢，\n\n02:51.845 --> 02:52.544\n是一个呢，\n\n02:52.544 --> 02:53.619\n是根据几个方面，\n\n02:53.619 --> 02:55.044\n一个是临床信息，\n\n02:55.494 --> 02:55.869\n嗯，\n\n02:55.869 --> 03:03.494\n主要是通过在采集以及是诊断以及鉴别诊断的相关信息，\n\n03:04.095 --> 03:06.244\n主要包括年龄职业。\n\n03:06.699 --> 03:07.949\n吸烟病史啊，\n\n03:08.000 --> 03:10.050\n慢性肺病的疾病史啊，\n\n03:10.850 --> 03:11.574\n个人呢，\n\n03:11.574 --> 03:12.050\n以及呢，\n\n03:12.050 --> 03:13.949\n是家族性的肿瘤病史啊。\n\n03:14.350 --> 03:15.000\n其中呢，\n\n03:15.000 --> 03:16.600\n包括他的治疗经过，\n\n03:16.600 --> 03:17.225\n以及呢，\n\n03:17.225 --> 03:18.199\n转归的情况。\n\n03:20.104 --> 03:20.830\n第二呢，\n\n03:20.830 --> 03:22.154\n是影像学的检查，\n\n03:22.304 --> 03:23.179\n也就是呢，\n\n03:23.179 --> 03:23.880\n推荐呢，\n\n03:23.880 --> 03:25.804\n是肺结节患者呢，\n\n03:25.804 --> 03:26.929\n行肺部结节，\n\n03:26.929 --> 03:28.354\n肺部CT的检查。\n\n03:30.223 --> 03:31.548\n有结节处呢，\n\n03:31.548 --> 03:32.048\n行呢，\n\n03:32.048 --> 03:41.348\n那个病灶的薄薄层CT的扫描至少达到1C级的以上的CT建议呢，\n\n03:41.348 --> 03:44.923\n设置低剂量的CT检测参数呢，\n\n03:44.923 --> 03:45.399\n以及呢，\n\n03:45.399 --> 03:47.923\n是扫描的范围为一是扫描参数呢，\n\n03:47.923 --> 03:52.723\n包括总辐射暴露剂量为一点零NSV。\n\n03:53.623 --> 03:54.274\n然后呢，\n\n03:54.274 --> 03:56.274\n是机架呢，\n\n03:56.274 --> 03:58.098\n螺旋速度为0.5。\n\n03:58.098 --> 03:59.024\n探测器呢。\n\n03:59.863 --> 04:00.214\n准呢，\n\n04:00.214 --> 04:03.164\n标直径应该小于等于1.5mm。\n\n04:03.714 --> 04:05.863\n扫描层厚是5mm。\n\n04:06.813 --> 04:07.164\n嗯，\n\n04:07.164 --> 04:07.839\n图像呢，\n\n04:07.839 --> 04:09.914\n重现层厚是1mm。\n\n04:09.914 --> 04:10.514\n这个呢，\n\n04:10.514 --> 04:11.988\n主要是然后呢，\n\n04:11.988 --> 04:12.914\n扫描的范围呢，\n\n04:12.914 --> 04:15.664\n从肺尖部到那个角。\n\n04:16.602 --> 04:18.102\n也就是要包括全部的费。\n\n04:18.993 --> 04:21.592\n扫描采采采样时间呢，\n\n04:21.592 --> 04:23.342\n应该是小于等于10秒。\n\n04:23.842 --> 04:25.143\n呼吸时像呢，\n\n04:25.143 --> 04:27.518\n为深吸气末。\n\n04:27.518 --> 04:28.542\nCT扫描呢，\n\n04:28.542 --> 04:29.592\n探测仪呢，\n\n04:29.743 --> 04:31.342\n大于等于16派。\n\n04:32.042 --> 04:32.442\n嗯，\n\n04:32.542 --> 04:34.643\n不需要注射对比剂。\n\n04:36.765 --> 04:37.315\n这个呢，\n\n04:37.315 --> 04:38.390\n评估的手段呢，\n\n04:38.390 --> 04:39.339\n包括一个呢，\n\n04:39.339 --> 04:40.614\n是肿瘤标志物，\n\n04:41.165 --> 04:41.864\n目前呢，\n\n04:41.864 --> 04:44.589\n尚没有特异性的生物学标志物呢，\n\n04:44.589 --> 04:46.265\n应用于肺癌的临床诊断。\n\n04:46.265 --> 04:46.839\n但是呢，\n\n04:46.839 --> 04:48.165\n有条件情况呢，\n\n04:48.165 --> 04:50.315\n可以酌情进行以下的筛查，\n\n04:51.015 --> 04:51.665\n一个呢，\n\n04:51.665 --> 04:53.815\n是胃泌素的释放肽前提。\n\n04:55.186 --> 04:56.061\nSCR,\n\n04:56.661 --> 04:58.010\n神经特异性的，\n\n04:58.460 --> 04:58.860\n嗯，\n\n04:58.860 --> 05:00.536\n纯化酶，\n\n05:00.536 --> 05:01.235\n也就呢，\n\n05:01.235 --> 05:04.335\n是NSE以前癌胚抗原。\n\n05:04.335 --> 05:06.911\nCEI可以对腺癌有针对性的检查，\n\n05:07.260 --> 05:09.710\n然后细胞角蛋白片段。\n\n05:10.968 --> 05:11.169\n嗯，\n\n05:11.169 --> 05:11.644\n这个呢，\n\n05:11.644 --> 05:13.544\n是对于鳞癌有有价值，\n\n05:13.544 --> 05:15.169\n然后还有鳞状细胞。\n\n05:17.420 --> 05:18.920\nA的抗原SCC。\n\n05:18.920 --> 05:20.321\n这也是针对鳞癌。\n\n05:24.563 --> 05:24.688\n嗯，\n\n05:24.688 --> 05:26.914\n功能显像对于不能确定。\n\n05:28.022 --> 05:28.696\n定性的呢，\n\n05:28.696 --> 05:32.247\n直径大于8cm的8mm的实性肺结节呢，\n\n05:32.247 --> 05:36.022\n采用派特吸气来区分良性或者恶性。\n\n05:37.022 --> 05:37.346\n嗯，\n\n05:37.346 --> 05:37.821\n此外呢，\n\n05:37.821 --> 05:38.846\n拍派特CT呢，\n\n05:38.846 --> 05:43.071\n可以作为选择性的穿刺活血部位提供重要的依据。\n\n05:44.023 --> 05:44.223\n嗯，\n\n05:44.223 --> 05:44.898\n其三呢，\n\n05:44.898 --> 05:46.699\n是动态增强CT扫描，\n\n05:46.699 --> 05:52.723\n对于良恶性的肺结节的鉴别诊断也是有一定的价值的。\n\n05:55.417 --> 05:55.768\n嗯，\n\n05:55.817 --> 05:57.317\n第五个评估诊断呢，\n\n05:57.317 --> 05:58.967\n就是非手术的活检。\n\n06:00.244 --> 06:00.644\n一个呢，\n\n06:00.644 --> 06:01.994\n是气管镜的检查。\n\n06:02.795 --> 06:04.119\n气管镜检查呢，\n\n06:04.119 --> 06:05.295\n主要是直视下呢，\n\n06:05.295 --> 06:07.369\n进行刷检啊，\n\n06:07.369 --> 06:08.470\n活检以及呢，\n\n06:08.470 --> 06:09.570\n透视镜下呢，\n\n06:09.570 --> 06:12.144\n进行的支气管镜肺活检。\n\n06:13.213 --> 06:13.313\n嗯，\n\n06:13.313 --> 06:18.914\n支气管肺泡灌洗自荧光气管镜，\n\n06:19.414 --> 06:23.463\n以及是电子虚拟导航的气管镜，\n\n06:23.463 --> 06:24.114\n还有呢，\n\n06:24.114 --> 06:25.914\n是电池导航气管镜。\n\n06:27.024 --> 06:27.774\n第四个呢，\n\n06:27.774 --> 06:29.200\n是还有呢，\n\n06:29.200 --> 06:32.825\n是经胸壁肺穿刺活检术。\n\n06:33.225 --> 06:33.850\n这个呢，\n\n06:33.850 --> 06:35.225\n是非手术的活检，\n\n06:35.475 --> 06:38.524\n主要是为了取得病理的那个，\n\n06:38.575 --> 06:39.825\n取得病理结果。\n\n06:40.024 --> 06:40.674\n然后呢，\n\n06:40.674 --> 06:41.450\n还第六个呢，\n\n06:41.450 --> 06:44.475\n手术活检也就是包括胸腔镜的检查。\n\n06:45.364 --> 06:45.690\n主要呢，\n\n06:45.690 --> 06:50.415\n适用于非手术活检无法取得病理结果标本的肺结节。\n\n06:51.500 --> 06:51.649\n嗯，\n\n06:51.649 --> 06:56.799\n对于术中明确为肺恶性的那个，\n\n06:57.200 --> 06:58.024\n小结线呢，\n\n06:58.024 --> 06:59.750\n可进行手术的根治。\n\n07:01.178 --> 07:01.604\n还有呢，\n\n07:01.604 --> 07:02.829\n是纵膈镜的检查，\n\n07:03.178 --> 07:05.378\n作为确诊肺癌以及呢，\n\n07:05.378 --> 07:08.821\n是评估淋巴结分期的有效方法。\n\n07:08.821 --> 07:14.253\n是目前临床评价肺癌患者纵膈淋巴结状态的近标准，\n\n07:14.253 --> 07:15.428\n可以弥补。\n\n07:16.411 --> 07:20.010\n那个EBUS的不足。\n\n07:24.579 --> 07:26.628\n影像学诊断要点以及呢，\n\n07:26.628 --> 07:29.854\n是临床恶性概念的评估。\n\n07:29.903 --> 07:33.329\n影像学诊断和鉴别诊断的要点，\n\n07:33.329 --> 07:34.903\n一个是外观评估。\n\n07:36.714 --> 07:36.815\n嗯，\n\n07:36.815 --> 07:38.640\n随着肺结节体积的增大，\n\n07:38.640 --> 07:41.515\n其恶性成概率也随之增加。\n\n07:41.915 --> 07:42.714\n形态呢，\n\n07:42.714 --> 07:48.214\n是大多数恶性肺结节多为圆形或者类类圆形。\n\n07:48.864 --> 07:51.214\n恶性亚实性结节呢，\n\n07:51.214 --> 07:54.915\n呈出现了不规则的形态的比例比较高。\n\n07:54.915 --> 07:55.714\n边缘呢，\n\n07:55.864 --> 08:01.190\n恶性肺结节多成为分叶分叶状或者有毛刺征啊，\n\n08:01.190 --> 08:03.739\n或者是脊状凸起啊，\n\n08:03.739 --> 08:05.364\n胸膜凹陷症以及呢，\n\n08:05.364 --> 08:06.864\n血血管素症。\n\n08:07.084 --> 08:09.584\n常提示恶性的可能性比较大。\n\n08:10.759 --> 08:15.759\n结节的到结节肺界面的恶性肺结节的边缘多清楚。\n\n08:16.903 --> 08:17.653\n但不光泽。\n\n08:18.776 --> 08:18.851\n嗯，\n\n08:18.851 --> 08:20.251\n结节肺间面的毛糙，\n\n08:20.251 --> 08:20.776\n或者呢，\n\n08:20.776 --> 08:22.026\n是有毛刺。\n\n08:22.075 --> 08:23.726\n内部的体征呢，\n\n08:23.726 --> 08:24.776\n是密度呢，\n\n08:24.776 --> 08:25.075\n是。\n\n08:26.688 --> 08:27.963\n平均CT值呢，\n\n08:27.963 --> 08:30.239\n对诊断鉴别诊断呢，\n\n08:30.239 --> 08:32.189\n具有重要的参考价值。\n\n08:33.208 --> 08:35.208\n密度高者恶性概率大，\n\n08:35.258 --> 08:39.458\n密度低则相对来说恶性概率比较低。\n\n08:40.008 --> 08:40.734\n结构呢，\n\n08:40.734 --> 08:42.533\n支气管被包埋，\n\n08:42.533 --> 08:46.258\n而且是伴有局部的管壁增厚啊，\n\n08:46.408 --> 08:49.309\n或者包埋的支气管管腔不规则啊，\n\n08:49.359 --> 08:51.458\n这恶性的可能性也比较大。\n\n08:54.124 --> 08:57.116\n影像学诊诊断和鉴别诊断的要点是，\n\n08:57.116 --> 08:58.374\n一个是功能显示，\n\n08:58.723 --> 09:02.948\n对于不能定型的直径大于8厘毫米的实性肺结节呢，\n\n09:02.948 --> 09:05.749\n建议进行功能显像增强。\n\n09:05.749 --> 09:06.573\nCT扫描呢，\n\n09:06.674 --> 09:13.624\n显示增强大于等于十五HU的提示恶性结节的可能性比较大的。\n\n09:15.877 --> 09:16.101\n第四，\n\n09:16.101 --> 09:17.677\n定期随访肺结节呢，\n\n09:17.677 --> 09:18.452\n在随访中呢，\n\n09:18.452 --> 09:19.802\n有以下变化者呢，\n\n09:19.802 --> 09:21.127\n多考虑为恶性，\n\n09:21.377 --> 09:23.526\n一个是直径增大，\n\n09:23.526 --> 09:26.077\n倍增时间符合肿瘤生长的规律。\n\n09:26.776 --> 09:27.351\n第二呢，\n\n09:27.351 --> 09:28.351\n是病灶缩小，\n\n09:28.351 --> 09:32.726\n但出现实性成分或其中成实性的成分增加。\n\n09:33.505 --> 09:33.755\n嗯。\n\n09:34.690 --> 09:35.065\n第四呢，\n\n09:35.065 --> 09:39.140\n是血管生成符合那个恶性肺结节的规律，\n\n09:39.140 --> 09:41.366\n出现分叶啊、毛刺啊，\n\n09:41.366 --> 09:43.640\n或者胸膜塌陷症、凹陷症。\n\n09:45.781 --> 09:45.906\n嗯，\n\n09:45.906 --> 09:48.856\n临床恶性概率的评估，\n\n09:48.856 --> 09:52.606\nACCP指南预测模型是恶性概率等于E，\n\n09:52.606 --> 09:52.932\nX.\n\n09:54.200 --> 09:54.799\n然后呢，\n\n09:54.799 --> 09:58.900\n结结合自然对年自年龄啊，\n\n09:59.299 --> 10:00.650\n有吸烟史啊，\n\n10:00.799 --> 10:05.299\n有胸外胸腔外肿瘤是大于五年，\n\n10:05.750 --> 10:06.424\n然后呢，\n\n10:06.424 --> 10:07.900\n结节直径啊，\n\n10:08.450 --> 10:10.299\n结节边缘有毛刺啊，\n\n10:10.750 --> 10:11.375\n然后呢，\n\n10:11.375 --> 10:12.900\n结节位于上叶啊。\n\n10:13.778 --> 10:14.703\n嗯，\n\n10:14.703 --> 10:15.453\nACCP指南中呢，\n\n10:15.453 --> 10:18.828\n是位于上叶的肺结节肿瘤概率是比较大的，\n\n10:18.979 --> 10:24.604\n但并不符合我国和大部分亚太地区的国家的和地区，\n\n10:24.604 --> 10:25.578\n因为商业。\n\n10:26.489 --> 10:29.789\n肩后段也是肺结核的高发部位。\n\n10:35.828 --> 10:36.153\n嗯，\n\n10:36.153 --> 10:41.478\n第四项是孤立性实性肺结节的评估以及处处理原则。\n\n10:43.301 --> 10:46.450\n肺部CT新发实现不确定的肺结节，\n\n10:46.500 --> 10:47.250\n也就是说，\n\n10:47.250 --> 10:49.950\n一般性是8mm到30mm之间。\n\n10:50.450 --> 10:52.401\n首先是评估手术的风险，\n\n10:53.250 --> 10:53.625\n嗯，\n\n10:53.625 --> 10:55.651\n评低中度风险呢，\n\n10:55.651 --> 10:59.000\n评估癌症的临床概率非常低。\n\n10:59.301 --> 11:00.250\n然后呢，\n\n11:00.750 --> 11:01.125\n嗯，\n\n11:01.125 --> 11:05.750\n小于5%低中等是5%.65%呢，\n\n11:05.750 --> 11:09.450\n是先是派特CT评估结节负的话，\n\n11:09.450 --> 11:11.450\n新度摄取在CT随访，\n\n11:11.750 --> 11:13.151\n然后呢在。\n\n11:13.400 --> 11:16.224\n是中等或者是强度摄取的，\n\n11:16.224 --> 11:19.000\n可以考虑非手术活检或者手术摘除。\n\n11:20.182 --> 11:20.481\n然后呢，\n\n11:20.481 --> 11:22.231\n评估手术风险的高风险呢，\n\n11:22.281 --> 11:23.807\n一个是非手术活检，\n\n11:23.807 --> 11:25.932\n包括恶性啊。\n\n11:26.831 --> 11:27.356\n然后呢，\n\n11:27.356 --> 11:28.031\n根据呢，\n\n11:28.481 --> 11:31.231\n拍的CT评估一下有没有转移。\n\n11:31.781 --> 11:36.331\n无转移的话是手术切除放射治疗或者是射频消融。\n\n11:36.932 --> 11:38.231\n高风风险呢，\n\n11:38.231 --> 11:40.132\n也是CT随访。\n\n11:40.984 --> 11:41.359\n然后呢，\n\n11:41.359 --> 11:42.434\n如果不能诊断，\n\n11:42.934 --> 11:43.559\n然后呢，\n\n11:43.559 --> 11:44.883\n是可以CT随访。\n\n11:44.883 --> 11:47.158\n如果是非手术的话呢，\n\n11:47.158 --> 11:48.059\n是良性的话呢，\n\n11:48.059 --> 11:49.984\n是定期特定治疗。\n\n11:53.827 --> 11:54.127\n然后呢，\n\n11:54.127 --> 11:57.276\n是影影响直径8.30mm。\n\n11:57.627 --> 11:57.976\n嗯，\n\n11:57.976 --> 12:01.002\n实性肺结节的处理结果的因素，\n\n12:01.002 --> 12:04.377\n一个是肺癌的临床概率是非常低，\n\n12:04.476 --> 12:05.827\n可以CT随访。\n\n12:06.127 --> 12:07.052\n低中毒呢，\n\n12:07.052 --> 12:10.226\n也是CT拍的CT或者是非手术活检。\n\n12:11.020 --> 12:11.096\n嗯，\n\n12:11.096 --> 12:12.520\n手术风险低的话呢，\n\n12:12.520 --> 12:15.870\n是然后还有根据活检的风险，\n\n12:16.270 --> 12:16.620\n嗯，\n\n12:16.620 --> 12:20.320\n那个价值观和意愿随访的依从性。\n\n12:22.176 --> 12:22.851\n然后呢，\n\n12:22.851 --> 12:24.075\n识别新的结节，\n\n12:24.075 --> 12:27.875\n也就是小于8mm的是否有肺癌的风危险因素。\n\n12:28.176 --> 12:28.625\n一个呢，\n\n12:28.625 --> 12:30.926\n是根据结节的大小表征，\n\n12:30.926 --> 12:32.325\n小于4mm的话呢，\n\n12:32.325 --> 12:35.851\n选择性的影像学随访，\n\n12:35.851 --> 12:36.526\n4.6mm的话呢，\n\n12:36.526 --> 12:39.176\n一般是12个月的那个影像随访，\n\n12:39.176 --> 12:41.226\n如稳定其后年度随访，\n\n12:41.276 --> 12:43.176\n常规随访，\n\n12:43.176 --> 12:43.926\n6.8mm的话呢，\n\n12:43.926 --> 12:44.226\n是。\n\n12:45.026 --> 12:46.276\n六十二十八，\n\n12:46.625 --> 12:47.825\n二十四个月，\n\n12:47.825 --> 12:50.250\n也就是6个月随访一次，\n\n12:50.250 --> 12:50.726\n6.8mm.\n\n12:50.875 --> 12:53.825\n如稳定其后年度常规随访。\n\n12:55.354 --> 12:56.030\n然后呢，\n\n12:56.030 --> 12:58.205\n根据结节的大小的本质，\n\n12:58.505 --> 13:00.630\n然后小于等于4mm的话呢，\n\n13:00.630 --> 13:00.905\n是。\n\n13:01.875 --> 13:03.174\n也是12个月水法。\n\n13:06.369 --> 13:07.695\n然后呢，\n\n13:07.695 --> 13:08.594\n4.6mm的话呢，\n\n13:08.594 --> 13:10.320\n也是半年随访一次。\n\n13:11.065 --> 13:11.440\n这个呢，\n\n13:11.440 --> 13:16.166\n因为可能是正在肺肺癌危险因素的是半年随访一次，\n\n13:17.065 --> 13:20.116\n如果是6到毫八毫米的话呢。\n\n13:20.986 --> 13:21.135\n嗯，\n\n13:21.135 --> 13:23.585\n也是具有肺癌危险因素的话呢，\n\n13:23.585 --> 13:26.236\n一般是是3到六个月随访一次。\n\n13:27.594 --> 13:28.619\n如果稳定话呢，\n\n13:28.619 --> 13:30.594\n也是年度常规随访。\n\n13:32.468 --> 13:32.794\n嗯，\n\n13:32.794 --> 13:36.494\n孤立性的亚实性的肺结部结节的评估以及处理呢，\n\n13:36.494 --> 13:37.468\n也是，\n\n13:37.468 --> 13:39.919\n根据那个小于5mm嘛，\n\n13:39.919 --> 13:42.169\n是定期CT随访，\n\n13:42.169 --> 13:43.169\n6个月一次。\n\n13:43.568 --> 13:45.044\n大于5mm的话呢，\n\n13:45.044 --> 13:46.718\n3个月影像学的随访。\n\n13:47.318 --> 13:49.119\n如果无无异常的话呢，\n\n13:49.119 --> 13:51.568\n是则年度常规随访。\n\n13:53.341 --> 13:53.742\n嗯，\n\n13:54.041 --> 13:57.091\n小于等于八毫米也是半三个月随访一次，\n\n13:57.192 --> 13:57.867\n但是呢，\n\n13:57.867 --> 14:01.742\n无病无密密切随访的话常为常规年度随访。\n\n14:01.791 --> 14:03.017\n大于8mm的话，\n\n14:03.017 --> 14:05.392\n应该是3个月的影像学垂随访。\n\n14:05.992 --> 14:08.992\n若如果结节处于长期损伤存在，\n\n14:08.992 --> 14:15.142\n则要排的吸气以及活肺手术活检或者是手术或者进一步的评估。\n\n14:17.284 --> 14:20.234\n多发性的肺结节的评估以及处理原则呢，\n\n14:20.234 --> 14:23.710\n是由一个或占主导或的结节或多个小结节。\n\n14:23.710 --> 14:24.159\n建议呢，\n\n14:24.159 --> 14:26.284\n是单独评估小结节，\n\n14:26.934 --> 14:32.885\n除非有主织学正实转移否则不可否定根治性的手术是IC期。\n\n14:33.534 --> 14:34.210\n然后呢，\n\n14:34.210 --> 14:36.909\n是对于多发性基因的毛玻璃样结节呢，\n\n14:36.909 --> 14:41.210\n至少有一个病变大于5mm或大是小于10mm的，\n\n14:41.210 --> 14:43.184\n又没有特殊的突出的病者呢，\n\n14:43.184 --> 14:45.684\n经推荐的是首次治疗后呢，\n\n14:45.684 --> 14:47.085\n3个月再进行CT垂。\n\n14:48.424 --> 14:48.823\n嗯，\n\n14:49.174 --> 14:49.848\n然后呢，\n\n14:49.848 --> 14:52.424\n对于一个以上的肺结节的肺癌患者呢，\n\n14:52.424 --> 14:56.249\n进行分类分类或者采取最佳存在困难时，\n\n14:56.249 --> 14:57.823\n建议多学科的讨论。\n\n14:58.874 --> 14:59.749\n一般认为，\n\n14:59.749 --> 15:03.223\n大于十个弥漫性的结节很可能伴有症状。\n\n15:04.182 --> 15:04.356\n嗯，\n\n15:04.356 --> 15:07.456\n可由胸胸外恶性肿瘤转移，\n\n15:07.456 --> 15:13.331\n或者是活动性的感染导致原发性肺癌的可能性呢，\n\n15:13.331 --> 15:14.581\n是相对比较低的，\n\n15:14.731 --> 15:16.731\n但仍需要进行仔细的。\n\n15:18.747 --> 15:19.497\n鉴别诊断。\n\n15:21.020 --> 15:22.320\n最后小结一下呢，\n\n15:22.320 --> 15:23.895\n是合理管理的肺结节，\n\n15:23.895 --> 15:29.570\n及时诊断早早期肺癌患者可产生显著的社会和经济效益。\n\n15:29.570 --> 15:34.169\n高危人群筛查评估分方法及诊断的要点。\n\n15:34.770 --> 15:35.145\n嗯，\n\n15:35.145 --> 15:35.719\n然后呢，\n\n15:35.719 --> 15:37.195\n孤立性的实性结节啊，\n\n15:37.195 --> 15:38.719\n孤立性的亚实性结节啊，\n\n15:38.719 --> 15:39.669\n多发性的结节。\n\n15:39.869 --> 15:40.469\n然后呢，\n\n15:40.469 --> 15:40.994\n即使呢，\n\n15:40.994 --> 15:42.369\n物联网技术的应用，\n\n15:42.770 --> 15:43.520\n谢谢啊。\n\n","v0d47cg10004d61vg6qljhtcp1r80jf0",946,578,0,"2026-01-25 04:32:34","肺结节定义与分类详解 - 诊断标准、类型与临床意义  ","肺结节定义,肺结节分类,肺部小结节,磨玻璃结节,实性结节,混合密度结节,肺癌筛查,CT诊断  ","本文系统讲解肺结节的定义、临床分类（包括实性/亚实性/磨玻璃结节）、良恶性鉴别特征及随访策略，帮助理解肺结节影像学诊断标准与分级管理的重要性。","2026-04-17 12:00:00",[37],{"menuId":38,"menuName":39,"parentId":30,"orderNum":40,"path":41,"component":42,"isFrame":43,"isCache":44,"menuType":45,"visible":21,"status":30,"createDept":6,"remark":24,"createTime":46,"children":47,"columnImage":48,"columnLogo":49,"uncheckedLogo":6,"checkedLogo":6,"isHot":30,"isHome":30,"forceLogin":30,"color":6,"seoTitle":50,"seoKeywords":51,"seoDescription":52,"contentNum":6,"promotionalPoster":53,"menuFrame":7,"innerLink":7,"parentView":7,"routeName":54,"routerPath":41,"componentInfo":42},"1986622624134549505","科普视频",3,"video","/video.html","1","0","T","2025-11-07 10:31:58",[],"https://ystcdn.venuertc.com/venue/undefined/2026-01-24-18:09:40/0d7fcb56-3dc4-4dcb-99ca-a5d5c438378e.png","https://ystcdn.venuertc.com/venue/undefined/2026-01-24-18:09:43/958efac7-dd02-4681-b8fd-0dd84b1bbf42.png","健康科普视频大全,了解你的健康生活","健康科普视频, 戒烟视频, 饮食健康视频, 胸痛科普, 用药知识, 职业健康视频, 贫血科普, 眼健康视频","精选健康科普视频,涵盖戒烟、胸痛、饮食、用药与职业健康等多个主题,让你轻松获取科学健康知识,提升生活质量。","https://ystcdn.venuertc.com/venue/undefined/2026-01-24-18:09:45/fa8fe113-deaa-4454-8105-d629769963dd.png","Video","慢性病",4,"https://vod.haohuanjiao.com/huanjiao/specialistVideo/865093/5891b5d0-f258-4e55-af98-be2824525d45.tmp?a=0&auth_key=1789027839-d93eaaaf548b4376bc3118d3b5e8871e-0-71e803ff955b52bb66d88df10102068e&br=435&bt=435&cd=0%7C0%7C0&ch=0&cr=0&cs=0&dr=0&ds=4&eid=v0d47cg10004d61vg6qljhtcp1r80jf0&er=0&l=20260811055450A04A414CB82A813A3090&lr=&mime_type=video_mp4&net=0&pl=0&qs=13&rc=M207NGZrbzl5OTczNGY3M0ApaTN1c3dtdGo0ZzMzajpneWdjLW9tcWduZC5hLS1kNGFzcy1nNS5gZWkzczMxLS5gMS06Yw%3D%3D&vl=&vr=",true,{"code":9,"msg":57,"message":6,"data":6,"success":58},{"code":9,"msg":10,"message":6,"data":61,"success":58},{"pageNo":21,"pageSize":62,"result":63,"totalSize":30},10,[],{"code":9,"msg":10,"message":6,"data":65,"success":58},{"authors":66,"appraiseDimensionScoresVos":67},[],[]]