周围型小肺癌98例临床分析

Small peripheral lung cancer: a clinical analysis of 98 cases

为了探讨周围型小肺癌的诊断和手术治疗经验,回顾性分析1986～2000年经手术治疗的98例周围型小肺癌患者的临床资料。术前诊断(CT导向下经皮肺穿刺活检)54例,术中诊断(快速病理)44例。肺叶切除76例,肺楔形切除13例,肺段切除9例。ⅠA期55例,ⅠB期21例,ⅡA期9例,ⅡB期8例,ⅢA期5例。1、3和5年生存率分别为83.7%(82/98)、63.3%(62/98)和49.0%(48/98)。Ⅰ期患者5年生存率77.6%(59/76),Ⅱ期患者5年生存率58.8%(10/17),Ⅲ期患者5年生存率40.0%(2/5)。鳞癌5年生存率91.3%(21/23),腺癌为64.1%(41/64),大细胞和小细胞癌为0(0/11)。回顾性分析结果提示,影像学筛查是检出周围型小肺癌的重要途径,CT引导下经皮肺肿块穿刺活检是周围型小肺癌确诊的重要手段,肺叶切除加系统的纵隔淋巴结清除术是周围型小肺癌的标准术式。

The objective of this study was to discuss the experience of diagnosis and surgical treatment of small peripheral lung cancer. A total of 98 cases of small peripheral lung cancer which underwent surgical treatment from 1986 to 2000 were analyzed retrospectively. Fifty-four cases were confirmed the diagnosis preoperatively by CT-mediated percutaneous lung mass biopsy, and 44 cases were diagnosed by rapid cryobiopsy during the opreation. The sur- gical treatment was as follows： lobectomy in 76 cases, wedge resection in 13 and segmentectomy in 9. The postoperative pathological stage consisted of stage Ⅰ A in 55 cases, stage Ⅰ B in 21, stage Ⅱ A in 9, stage Ⅱ B in 8, and stage Ⅲ A in 5. For the overall groups of 98 cases, the 1-,3-,5-year survival rates were 83. 7% （82/98） ,63.3% （62/98） and 49.0% （48/98） respectively. The 5-year surival rate was 77.6% （59/76） in stage Ⅰ , 58. 8% （10/17） in stage Ⅱ and 40.0% （2/5） in stage UI. Among the postoperative histological type, the 5-year surival rate was 91.3% （21/23） in squmous cell carcinoma and 64. 1 % （41/64） in adenocarcinoma. The 5-year survival rate of 11 cases with large cell or small-cell lung cancer was 0（0/11）. In conclusions, radiological screening is an important way to detect small peripheral lung cancer; CT-mediated percutaneous lung mass biopsy is an important approach to confirm small peripheral lung cancer. The standard operative procedure for treating small peripheral lung cancer is lobectomy plus systematical removal of mediastinal lymph node.