原发性肺癌TNM分期临床应用价值的探讨

Study on clinical application value of the TNM stage of primary pulmonary carcinoma

[目的]探讨肺癌术前、术中按TNM分期(恶性肿瘤国际临床病期分类 T:肿瘤 N:结节,淋巴结 M:转移)的对比情况。[方法]随机单盲收住69例患者,术前依据病史、检查按TNM分期分级分类判断,然后术中按TNM分期分级分类记录,进行综合对比分析。[结果]①中心型:鳞癌、腺癌转移早,手术的根治率低,鳞癌术前、术中与根除有明显相关。②周围型:鳞癌术前、术中所见符合率低,腺癌占50％,术前、术中所见符合率高,手术根除率高。③中心型与周围型:腺癌占39.13％,呈上升趋势,小细胞未分化癌术前诊断与术中所见,提示转移早。④上纵隔影宽、主动脉前突出饱满,隆突角≥90°示肺癌Ⅲa,手术困难。[结论]X线、CT、B超、MRI检查可相互弥补,以提高诊断符合率,正确判断手术指征,制订手术方案。

[Objective]To study the comparison of pulmonary carcinoma of pre - operation with that of operation on TNM stage. [Method] 69 patients with unilateral blindness were selected randomly. All patients were judged on TNM stage according to medical history and examination before operation. 'Then these patients were comprehensively analyzed on TNM stage during operation. [Result]① Center type: metastasis of squamous carcinoma and adenocarcinoma was early and its radical operation rate was low. There was distinctive relations between operation and radical cure rate. ② Peripheral type: The diagnosis of pre - operation had little coincidence with that of operation about squamous carcinoma. While the coincidence rate of adenocarcinoma was high and its radical operation rate was high too. ③Central and peripheral type: adenocarcinoma rate is 39.13% and it has a ascending trend, Small cell undifferentiated carcinoma of lung transfers early according ot preoperative diagnosis and what was seen during operation. ④ Ⅲ a of pulmonary carcinoma with wide shadow of superior mediastinum .prominent of aortic arch and protuberance corner not smaller than 90·is difficult for operation. [Conclusion]X - ray, CT, B - ultrasonic examination and MRI may supplement each other to improve diagnostic coincidence rate, to judge operation indication rightly and to draw up operative programs.