临床Ⅰ期周围型非小细胞肺癌手术切除淋巴结清扫模式探讨

Model research on reasonable dissection extent of mediastinal lymph nodes in peripheral non-small cell lung cancer of stage CⅠ

目的探讨临床Ⅰ期周围型非小细胞肺癌手术切除淋巴结清扫的合理模式。方法通过对68例临床Ⅰ期周围型非小细胞肺癌术前临床资料的分析,选择合理的手术切除和纵膈淋巴结清扫范围。结果肿瘤位于肺上叶,50.0%发生同侧肺门和纵隔淋巴结转移,33.3%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22.4%和14.3%(P=0.018),腺癌发生纵隔淋巴结转移的风险是鳞癌的1.73倍(OR值为1.73);淋巴结转移同瘤体大小密切相关,瘤体最大直径在1.0 cm以下、无纵膈淋巴结转移和无胸膜受侵,对患者生存率的影响差异尤为显著(P<0.01)。讨论临床Ⅰ期周围型非小细胞肺癌手术切除应行包括隆突下淋巴结在内的选择性区域纵膈淋巴结清扫,精准合理的纵隔淋巴结清扫可提高临床I期周围型非小细胞肺癌的生存率。

【Objective】 To discuss the model of reasonable dissection extent of mediastinal lymph nodes in peripheral non-small cell lung cancer of stage CⅠ.【Methods】 A study was carried on the clinical data of 72 patients with peripheral NSCLC of stage CⅠ,according to the size of tumor undergoing curative resection and mediastinal lymph nodes dissection.【Results】 50.0% mediastinal lymph node metastasis of superior lobe tumor,33.3% transferingto surcarinal node;The mediastinal lymph node metastasic rate of adenocarcinom was 22.4%,and squamous cell carcinoma was 14.3%（P =0.021）.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.【Conclusion】 Regional mediastinal lymph nodal and surcarinal lymph nodal dissection should be routinely performed on patients with peripheral non-small cell lung cancer of stage CⅠ,and improve survival rate.