直径在2 cm以下非小细胞肺癌淋巴结清扫的临床分析

Clincal research on Surgical treatment for non-small cell lung cancer of diameter less than 2 cm

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.