CT评估Ⅲa期肺癌手术切除可行性的临床研究

Clinical study of stage Ⅲ a lung cancer resectability evaluated by chest CT manifestation

目的 探讨Ⅲa 期肺癌胸部CT表现与手术切除可行性的关系。方法 全组 70例Ⅲa 期肺癌患者分别以CT TNM分类和不同术式分为 3组 ,分别测量各组胸部CT肿瘤瘤体直径、纵隔肺门淋巴结受侵CT层厚。结果 CT TNM分类组T2 N2 、T3N1和T3N2 瘤体直径分别为 4.0 7± 0 .92、6 .3 3± 3 .6 9和 4.94± 1.83 ( x±s)cm (P <0 .0 5 )。纵隔肺门淋巴结层厚分别为 4.2 3± 2 .96、2 .76± 1.2 8、4.18± 2 .0 7cm(P >0 .0 5 )。不同术式组中根治性切除组、姑息性切除组以及手术探查组瘤体直径分别为 4.5 5± 1.96、4.18± 1.6 0、5 .6 2± 3 .2 3cm (P >0 .0 5 ) ,纵隔肺门淋巴结层厚分别为 3 .14± 1.89、4.3 5± 1.41、5 .0 3±3 .0 5cm(P <0 .0 5 )。结论 Ⅲa 期肺癌纵隔肺门淋巴结受侵、CT纵向厚度改变是影响手术切除的重要因素之一。

Objective To evaluate the relationship between resectability of the cancer and its chest CT manifastation in stage Ⅲ a lung cancer.Methods Seventy stage Ⅲ a lung cancer patients were divided into 3 groups respectively by CT TNM stage as well as different surgical types. The diameter of tumor, the proximity to mediastinum and/or the hilum and the invasion of their lymph nodes on each group were measured.Results The diameter of tumor at T 2N 1, T 2N 2 and T 3N 2 by CT TNM classfication was 4.07±0.92, 6.33±3.69, 4.94±1.83cm (±s) respectively (P<0.05). The proximity to mediastinum and/or the hilum and the invasion of their lymph nodes was 4.23±2.96, 2.76±1.28, 4.18±2.07cm (P>0.05) . On the contrary, the diameter of the tumor at the radical resection group, palliative resection group and exploratory thoractomy group by surgical type classfication was 4.55±1.96, 4.18 ±1.60, 5.62±3.23cm (P>0.05), and the proximity to mediastinum and/or the hilum and the invasion of their lymph nodes was 3.14±1.89, 4.35±1.41, 5.03±3.05 (P<0.05).Conclusion The extent of the proximity to mediastinum and/or the hilum and invasion of their lymph nodes is one of the main factors which affect the resectablility in stage Ⅲ a lung cancer.