检索历史 清除

目的 探讨直径2 cm以下非小细胞肺癌手术切除及淋巴结清扫的方法.方法 收集2004年4月至2007年3月郑州大学第一附属医院192例经高分辨CT确定瘤体最大直径在2 cm以下的非小细胞肺癌术前临床资料、术中所见和快速病理,分析选择合理的手术切除和纵隔淋巴结清扫范围.结果 瘤体直径在1 cm以下、无纵隔淋巴结转移和无胸膜受侵,对患者生存率的影响差异有统计学意义(P＜0.01).肿瘤位于肺上叶,51.7％(61/118)发生同侧肺门和纵隔淋巴结转移,28.8％(38/192)发生隆凸下淋巴结转移；腺癌、鳞癌纵隔淋巴结转移发生率为32.2％和15.4％(P=0.0012),腺癌发生纵隔淋巴结转移的风险是鳞癌的1.97倍(OR值为1.97).结论 直径2 cm以下的非小细胞肺癌手术切除时无论瘤体大小,只要患者的心肺功能等许可,应行包括隆突下淋巴结在内的区域纵隔淋巴结清扫,精准合理的纵隔淋巴结清扫可明显提高早期非小细胞肺癌的生存率.

Objective To discuss the model of reasonable dissection extent of mediastinal lymph nodes in non-small cell lung cancer of diameter less than 2 cm.Method A study was carried on the clincal data of 192 patients with NSCLC of diameter less than 2 cm undergoing curative resection and mediastinal lymph nodes dissection,According to the size of tumor and the pathology quick report.Results The survival rates of patient was statistically significant difference (P ＜ 0.01),prognostic factors included diameter of tumor,lymph node metastasis and visceral pleura invasion; 51.7％ mediastinal lymph node metastasis of superior lobe tumor,28.8％ transferingto surcarinal node; the mediastinal lymph node metastasic rate of adenocarcinom was32.2％,and squamous cell carcinom was 15.4％ (P =0.0012).Conclusion If the patient's cardiopulmonary function permitting,regardless of the size of focus,Regional mediastinal lymph nodal and surcarinal lymph nodal dissection should be routinely performed on patients with non-small cell lung cancer of diameter less than 2 cm,and improve survival rate.