256排CT三期增强扫描对NSCLC纵膈淋巴结转移及分布规律的评估分析

Evaluation of Mediastinal Lymph Node Metastasis and Distribution in NSCLC with256-slice Spiral Computed Tomography Triple-phase Enhanced Scanning

目的经256排CT三期增强扫描评估非小细胞肺癌(NSCLC)纵膈淋巴结转移及分布规律。方法回顾性分析149例NSCLC患者临床资料,所有患者术前均经256排CT三期增强扫描检查。分析不同肿瘤大小、胸膜凹陷、累及粗大肺静脉、淋巴结短径、肿大淋巴结位置、肿瘤位置情况下纵膈淋巴结转移情况,分析不同直径淋巴结在各区域分布情况。结果149例NSCLC患者共清扫淋巴结980组,共2903枚,病理证实91例患者142组588枚淋巴结存在转移,淋巴结转移率61.07%;不同肿瘤大小、胸膜凹陷情况、累及粗大肺静脉情况、肿大淋巴结位置NSCLC患者淋巴结转移率比较差异均有统计学意义(P<0.05);淋巴结短径≤1 cm NSCLC患者淋巴结转移率明显低于淋巴结短径>1 cm者(P<0.05);阳性转移淋巴结主要分布在纵膈淋巴结上区、N1淋巴结区,阴性转移淋巴结主要分布在纵膈淋巴结上区、主动脉淋巴结AP区,不同性质淋巴结转移在各区域分布存在显著差异(P<0.05)。结论256排CT三期增强扫描能及时发现NSCLC纵膈淋巴转移,结合NSCLC临床特征及淋巴结分布特点能进一步评估NSCLC纵膈淋巴转移,为临床诊疗提供参考。

Objective To evaluate the mediastinal lymph node metastasis and distribution in non-small cell lung cancer(NSCLC)with 256-slice spiral computed tomography triple-phase enhanced scanning.Methods The clinical data of 149 NSCLC patients were retrospectively analyzed.All patients were examined by 256-slice spiral computed tomography triple-phase enhanced scanning.The mediastinal lymph node metastasis was analyzed in terms of tumor size,pleural indentation,involvement of large pulmonary vein,short diameter of lymph node,location of enlarged lymph node,and location of tumor.Results 2903 lymph nodes were dissected in 149 NSCLC patients in 980 node groups.Pathology confirmed the presence of metastasis in 588 lymph nodes in 142 node groups of 91 patients,with a lymph node metastasis rate of 61.07%.The lymph node metastasis rate of NSCLC patients with different tumor sizes,pleural indentation,involvement of large pulmonary veins,and location of enlarged lymph node showed significant difference(P<0.05).The lymph node metastasis rate of NSCLC patients with lymph node diameter≤1 cm was significantly lower than that of patients with lymph node diameter>1 cm(P<0.05).The positive metastatic lymph nodes were mainly distributed in the superior mediastinal lymph node region and N1 lymph node region,while the negative metastatic lymph nodes were mainly distributed in the superior mediastinal lymph node region and the aortic lymph node AP region.The distribution of lymph node metastasis of different nature was significantly different in each region(P<0.05).Conclusion Application of 256-slice spiral computed tomography triple-phase enhanced scanning can detect the mediastinal lymph node metastasis of NSCLC,and the evaluation of mediastinal lymph node metastasis can be based on clinical characteristics and lymph node distribution characteristics,which can provide reference for clinical diagnosis and treatment.