T_1期非小细胞肺癌清扫肺内淋巴结的临床意义

Clinical Significance of Lymph Node inside Lung Dissection of Non-small Cell Lung Cancer in Stage T_1

目的探讨TNM分期（UICC 2011）中T_1期（肿物直径d≤3 cm）的原发性周围型非小细胞肺癌（NSCLC）的淋巴结转移规律,并尽可能找出对患者收益最大化的淋巴结清扫方式。方法回顾性分析2014年11月至2015年5月大连市中心医院胸外科60例原发性周围型NSCLC的临床资料,其中男26例、女34例,年龄34-76（57.91±7.75）岁。记录淋巴结清扫数目及转移情况。结果全组共清扫淋巴结1 208枚,平均每例清扫20.1枚,其中转移淋巴结33枚,转移率为2.73%。常规病理检测未发现纵隔及肺门淋巴结转移51患者。检出单纯第12和（或）13和（或）14组淋巴结转移者共3例,检出率为5.89%。对于T1期原发性周围型NSCLC,随着肿瘤直径增加,淋巴结转移率逐渐升高。实性病灶较非实性病灶[纯磨玻璃结节（p GGO）或混合磨玻璃结节（m GGO）]更易发生淋巴结转移,而非实性病灶一般不会发生淋巴结转移。结论 T_1期原发性周围型NSCLC的淋巴结转移率与肿物直径、性质、病理类型、影像学局部胸膜牵拉有关系,肺内第（12＋13＋14）组淋巴结清扫能发现可能存在的单纯肺内淋巴结转移,对T_1期原发性NSCLC的分期的划定和治疗方案的选择有重要意义。

Objective To investigate the primary peripheral non-small cell lung cancer（NSCLC）in stage T1 of TNM（UICC 2011）（the tumor size ≤ 3 cm）and to find out the lymphadenectomy way which will benefit patients most.Methods We retrospectively analyzed the clinical data of 60 patients with primary peripheral NSCLC in our hospital between November 2014 and May 2015.There were 26 males and 34 females at age of 34-76（57.91 ± 7.75）years.The lymph nodes dissection and metastasis were recorded.Results The total number of intrathoracic lymph nodes dissection is 1 208,with an average of 20.1,including 33 metastasis lymph nodes.The metastasis rate was 2.73 %.A total of 51 patients were not found the mediastinum and hilum metastasis lymph node through the routine pathological detection method,while metastasis lymph node in section 12 and（or）13 and（or）14 group were found in 3 patients in our trial.The detection rate was 5.89 %.For stage T1 primary peripheral NSCLC,with increasing tumor size,lymph node metastasis rate was gradually increased.The patients with solid lesions were more likely to have lymph node metastasis than those with non-solid lesions（pure ground-glass nodules or mixed ground-glass nodules）which generally did not find lymph node metastasis.Conclusion The lymph node metastasis rate in stage T1 primary peripheral NSCLC is related to the tumor size,nature,histological type,local pleural stretch in imaging.The dissection of lung lymph node（12 ＋ 13 ＋ 14 groups）may be able to find simple intrapulmonary lymph nodes metastasis.It is important to the selection of delineated staging and treatment program in stage T1 primary peripheral NSCLC.