61例肺部多发病灶患者的外科治疗

Surgical treatment for 61 patients with multiple lung lesions

目的分析肺部多发病灶患者的外科治疗效果,为临床诊疗提供依据。方法选择2012年5月至2016年4月我院胸外科61例临床资料保存完整且术前临床诊断为同时性多原发非小细胞肺癌(SMPLC)的病例,对这些患者的临床病理学特征、外科治疗及术后生存情况进行回顾性分析。结果 61例肺部多发病灶患者中,47例存在2处或以上恶性病灶,10例存在1处恶性病灶,4例病灶全为良性。41例患者确诊为SMPLC,1年和3年总生存率分别为97.0%和77.5%。肿瘤最大直径越小(χ~2=10.918,P=0.012)、病灶实性成分越少(χ~2=10.754,P=0.005)、无淋巴结转移(χ~2=10.234,P=0.001)以及TNM分期越早(χ~2=12.068,P=0.007)的SMPLC患者预后越好。结论对于肺部多发病灶患者,若考虑SMPLC可能性大且胸部CT无纵隔淋巴结转移,建议首选手术治疗。

Objective To provide experiences for clinical diagnosis and treatment by analyzing the surgical outcomes for patients with multiple lung lesions. Methods Clinical data of 61 patients with clinical diagnosis of synchronous multiple primary non-small cell lung cancer（ SMPLC） were collected from May 2012 to Apr. 2016 in our hospital. The clinicopathologic features,surgical treatment and overall survival（ OS） were retrospectively analyzed. Results Among the 61 patients,47 patients were verified with more than one malignant tumors. Ten patients were verified with only one malignant tumor,and all lesions of the other 4 patients were benign. Forty-one patients were finally diagnosed with SMPLC after surgical treatment. The 1-year and 3-year OS rates were 97. 0% and 77. 5%,respectively. Smaller dimension of maximal tumor（ χ2= 10. 918,P = 0. 012）,lesions with less solid ingredient（ χ2= 10. 754,P = 0. 005）,lymph nodes metastases negative（ χ2= 10. 234,P = 0. 001） and earlier TNMstage（ χ2= 12. 068,P = 0. 007） were correlated with better OS. Conclusion For patients with multiple lung lesions,if the diagnosis of SMPLC can not be excluded and there is no lymph nodes metastases in thoracic computed tomography,surgical treatment can be considered preferentially.