重症肺功能不全肺癌局限性切除术后切缘阳性的多因素分析

Multivariate analysis of positive margins in patients undergoing limited surgery for lung cancer with severe lower respiratory function

目的研究重症肺功能不全肺癌局部切除影响切缘阳性的因素。探讨肺癌局限性切除术在重症肺功能不全患者治疗中的应用指征,哪些患者最能从此方法受益。方法选择2001年5月至2008年1月重症肺功能不全肺癌患者59例,行术中肺灌洗细胞学诊断技术判断局部切除术后病肺切缘情况。采用单因素分析、Logistic多因素分析年龄、性别、病理类型、组织分化、肿瘤大小、淋巴结转移和局部切除术后切缘阳性的关系。结果59例患者中10例手术边缘阳性(16.95%)。肿瘤直径>2.0cm、淋巴结转移与重症肺功能不全肺癌患者局限性切除切缘阳性密切相关。结论对肿瘤直径≤2.0cm且无淋巴结转移的重症肺功能不全肺癌患者,行局限性切除术并行肺灌洗细胞学检查最为有益。

Objective To analyze the influential factors regarding the positive margins in limited pulmonary resection patients for lung cancer with severe lower respiratory function and explore the applied indication to make clear what kind of patients can be benefit from the surgery.Methods From May 2001 to January 2008,lung cancer patients with severe lower respiratory function were treated with lavage cytologic analysis of surgical margins.Age,gender,tumor type,tumor size,lymph nodes metastasis were analyzed concerning their influence of positive margins using univariate and multivariate Logistic regression.Results 10 of the sample tissues （16.95%） were malignant positive.Tumor size 〉2.0 and lymph nodes metastasis were tended to be associated with positive margins.Conclusion lung cancer patients with severe lower respiratory function can be benefit from the limited surgery with the tumor size≤2 cm and no lymph nodes metastasis.Intraoper-ative lavage cytologic analysis of surgical margins should be performed.