摘要：由于缺乏正式的官方指南，系统使用术中冰冻切片评估肺肿瘤手术切缘是许多病理科的标准做法。由于报吿的切缘阳性率很低，这种昂贵且耗时的方法似乎并不合理。我们的目的是评估与切缘阳性相关的临床病理学标准参数，并提出有关使用冰冻切片的循证医学建议。该回顾性队列纳入2006~2015年间因恶性肿瘤行肺切除的1903例连续性病例。从医疗档案中收集临床病理学数据。采用单变量和多变量分析确定与阳性切缘相关的变量。基于肿瘤-切缘距离建立与阳性切缘相关的受试者特征曲线和概率表。本研究结果在27例切缘阳性患者的验证队列中得到证实，其切缘阳性率为3.8%，48.6%的患者因切缘阳性而改变了手术治疔方案。在单变量和多变量分析中发现，大体巨检肿瘤-切缘距离过近与支气管血管和肺实质切缘的较高阳性率相关。设定肿瘤-切缘距离2.0 cm作为界值将减少55.3%的术中冰冻切片，而遗漏切缘阳性的比率仅0.61%。总体来说，我们发现，系统地使用冰冻切片进行手术切缘的术中评估并非必要，对具有切缘阳性高风险的患者选择巨检肿瘤-切缘距离作为简单评估参数是更好的方式。
关键词：肺肿瘤切除术，冰冻切片，手术切缘
（Am J Surg Pathol 2018;42:1495-1502）
美国外科病理学杂志中文版2019年第2期全文No.3
（刘逸风 翻译 唐 峰 审校）
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