Abstract: Background　 The detection rate of multiple ground-glass nodules（GGNs） in the lung is increasing with the widening application of spiral CT in lung disease screening and people's increased awareness and participation in physical examination.The management of single ground-glass nodule in the lung can follow the guidelines published by the Fleischner Society and NCCN，but there is no reference for the management of multiple GGNs in the lung.Objective To develop a diagnosis and treatment procedure for multiple GGNs in the lung based on analyzing clinical imaging data and results of CT-guided puncture biopsy of such patients，providing a reference for clinical practice.Methods In this study we summarized the data of 54 patients with multiple GGNs in the lung recruited from Department of Thoracic Surgery，the 4th Hospital of HeBei Medical University from May 2015 to December 2018.All the patients underwent thin-slice chest CT scan and all the GGNs were marked and the dominant lesions were figured out by characteristics of the lesions，including shape，density，diameter and proportion of solid components.Afterwards，CT guided puncture biopsy was performed according to the location and characteristics of the GGNs，and treatment strategies were formed accordingly.Results A total of 140 GGNs lesions were detected in the 54 patients，including 58 dominant lesions and 82 non-dominant lesions.CT-guided puncture was performed in 15 unilateral cases and 10 bilateral cases.Puncture pathology results proved that there were 20 cases of adenocarcinoma，12 cases of lepidicpredominant tumor，and 3 cases of benign tumor.Seven cases did not undergo surgery（including 2 receiving targeted drug therapy，3 with benign lesions found by biopsy，and 2 receiving radiofrequency ablation），other 47 underwent thoracic surgery，but all of them were discharged after successful treatment.A total of 50（86.2%） dominant lesions and 35（42.7%） non-dominant lesions were resected.Finally，19 cases of synchronous multiple primary lung cancer，26 cases of primary lung cancer，1 case of atypical epithelioid nodule and 1 case of atypical adenomatous hyperplasia（AAH） were diagnosed.At the same time，there were other 55 GGNs were followed up.All patients were followed up from 2 to 43 months and were all in good health.Conclusion According to the imaging data and the pathological results of CT guided puncture，appropriate surgical strategy can be worked out for multiple GGNs before surgery，so that reasonable diagnosis and treatment be made up to avoid unnecessary surgery.

Key words: Sarcoidosis, pulmonary；Multiple pulmonary nodules；Punctures；Diagnosis ；Therapy

摘要： 背景　随着螺旋CT在肺部疾病筛查中的应用和人们体检意识的提高，越来越多的肺部同时性多发磨玻璃结节（SM GGNs）被发现。目前Fleischner学会和美国国立综合癌症网络（NCCN）出台了单发磨玻璃结节的诊断和治疗指南，但对于SM GGNs的诊治尚无公认的参考经验。目的　结合肺部SM GGNs患者影像学资料及CT引导下穿刺活检病理结果制定肺部SM GGNs的诊治流程，以期为临床提供参考。方法　收集河北医科大学第四医院胸外科2015年5月—2018年12月诊治的54例肺部SM GGNs患者的临床资料，患者均行胸部薄层CT扫描并标注病灶，根据病灶形态、直径、密度、实性成分占比，将符合标准的病灶设立为主导病灶。结合病灶位置和特点进行CT引导下穿刺活检，根据病理结果采取不同的治疗策略。结果　54例患者共检出病灶140个，其中主导病灶58个，非主导病灶82个。CT引导下穿刺单侧15例，双侧10例。穿刺病理结果示：腺癌20个、伏壁状肿瘤12个、良性结节3个。54例患者中7例（服用靶向药物2例、穿刺结果为良性疾病3例、射频消融治疗2例）未行手术，余47例行胸腔镜下手术治疗，均顺利出院。共切除主导病灶50（86.2%）个和非主导病灶35（42.7%）个，诊断同时性多原发肺癌19例，原发肺癌26例，非典型上皮样结节及非典型腺瘤样增生各1例，继续随访磨玻璃结节（GGNs ）55个。所有患者随访2~43个月，健康生存。结论　SM GGNs术前可根据影像学资料和CT穿刺病理结果制定合适手术策略，使患者得到合理诊治，避免不必要手术。

关键词: 结节病, 肺；多发性肺结节；穿刺术；诊断；治疗