临床Ⅰ期非小细胞肺癌的选择性纵隔淋巴结清扫

Selective mediastinal lymphadenectomy for clinical stage Ⅰ non-small cell lung cancer

目的 分析选择性纵隔淋巴结清扫和系统性纵隔淋巴结清扫对临床Ⅰ期非小细胞肺癌患者生存和围手术期指标的影响,以探讨前者的临床价值.方法 回顾性分析984例临床Ⅰ期非小细胞肺癌病例的临床资料,患者均接受肺叶切除术加纵隔淋巴结清扫术,其中男581例,女403例;年龄24～ 84岁,平均（59.6±10.2）岁.其中786例接受系统性纵隔淋巴结清扫,198例接受选择性纵隔淋巴结清扫.结果 选择性纵隔淋巴结清扫组的手术时间（132.3±30.3） min,系统性纵隔淋巴结清扫组的平均手术时间（150.7±41.8） min,两组差异有统计学意义（P＜0.01）.选择性纵隔淋巴结清扫组平均术中出血量（96.2±53.5） ml,系统性纵隔淋巴结清扫组平均术中出血量（124.4±65.4） ml,差异有统计学意义（P＜0.01）.两组生存率差异无统计学意义（P=0.844）,选择性纵隔淋巴结清扫组总体复发率25.3％,系统性纵隔淋巴结清扫组总体复发率27.5％,差异无统计学意义（P=0.533）.亚组分析中,两组的5年生存率差异均无统计学意义.结论 对于临床Ⅰ期非小细胞肺癌,选择性纵隔淋巴结清扫的生存不劣于系统性纵隔淋巴结清扫,且手术时间更短,术中出血量更少.

Objective To analyze the survival statistics and perioperative parameters of clinical stage Ⅰ non-small cell lung cancer patients who received systemic or selective mediastinal lymphadenectomy,and explore the value of selective mediastinal lymphadenectomy for clinical stage Ⅰ non-small cell lung cancer.Methods The clinical data of 984 patients with clinical stage Ⅰ non-small cell lung cancer who underwent lobectomy and systemic/selective lymph node dissection in Zhongshan Hospital from January 2005 to December 2010 were analyzed retrospectively.There were 581 males and 403 females with an average age of（59.6 ± 10.2） （24-84） years.786 patients received systemic mediastinal lymphadenectomy,and 198 patients received selective mediastinal lymphadenectomy.Results Average operation time of selective mediastinal lymphadenectomy group was（132.3 ±30.3） minutes,and that of systemic mediastinal lymphadenectomy group was（150.7 ±41.8） minutes with significant difference（P 〈 0.01）.Average amount of intraoperative bleeding of selective mediastinal lymphadenectomy group was （96.2± 53.5） ml,and that of systemic mediastinal lymphadenectomy group was （124.4 ±65.4） ml with significant difference（P 〈0.01）.There was no significant difference in overall survival rate between two groups（P =0.844）.Recurrence rates were 25.3 % and 27.5 %,respectively （P =0.533）.Subgroup analysis showed no significant difference of 5-year survival rates between the two groups.Conclusion For patients with clinical stage Ⅰ non-small cell lung cancer,selective mediastinal lymphadenectomy can reduce operation time and amount of intraoperative bleeding.Survival of patients who received selective mediastinal lymphadenectomy was no worse than that of patients who received systemic mediastinal lymphadenectomy.