外科切除右肺上叶ⅠA期非小细胞肺癌:术式选择影响因素

Impact factors of the choice of surgical resection methods for stageⅠA non-small cell lung carcinoma in right upper lobe

目的观察外科切除右肺上叶ⅠA期非小细胞肺癌(NSCLC)术式的影响因素。方法收集100例ⅠA期NSCLC患者,观察接受以不同术式切除右肺上叶单发病灶患者一般资料、CT及手术资料;行logistic回归分析,评估影响术式选择的因素。结果100例右上肺NSCLC病灶中,术前影像学分期为T1a期56例、T1b期29例、T1c期15例。对其中50例行右肺上叶切除术、39例行病灶楔形切除术、11例行载瘤肺段切除术;术后病理示非典型腺瘤样增生1例,原位腺癌3例,微浸润腺癌24例,浸润性腺癌67例,鳞状细胞癌2例,大细胞未分化癌1例,腺鳞癌1例,大细胞神经内分泌癌1例。接受3种术式患者之间,全身状况、术前影像学分期、术后病理分型及病灶位置差异均有统计学意义(P均<0.05)。术后病理分型是临床选择对右肺上叶ⅠA期NSCLC病灶行楔形切除术或右肺上叶切除术的影响因素(P=0.002),术前影像学分期为选择行载瘤肺段切除术或右肺上叶切除术的影响因素(P=0.033)。结论术前影像学分期及术后病理分型是选择外科切除ⅠA期NSCLC右肺上叶病灶术式的影响因素。

Objective To observe the impact factors of the choice of surgical methods for stageⅠA non-small cell lung carcinoma(NSCLC)in the right upper lobe.Methods A total of 100 patients with stageⅠA NSCLC in the right upper lobe were enrolled.The general data,CT data and surgical data of patients with single NSCLC lesion in the right upper lobe and treated with different surgical methods were observed,and the impact factors of the choice of surgical methods were explored with logistic regression analysis.Results Among 100 cases of NSCLC,preoperative imaging showed 56 cases of stage T1a,29 cases of T1b and 15 cases of T1c.Fifty cases underwent lobectomy of the right upper lobe of lung,while 39 cases underwent wedge resection and 11 cases underwent segmental resection of the right upper lobe.Postoperative pathology showed 1 case of atypical adenomatous hyperplasia,3 of adenocarcinoma in situ,24 of minimally invasive adenocarcinoma,67 of invasive adenocarcinoma,2 of squamous cell carcinoma,1 of large cell undifferentiated carcinoma,1 of adenosquamous carcinoma and 1 case of large cell neuroendocrine carcinoma.There were significant differences of patients'general condition,preoperative image stage,postoperative pathological classification and lesion location among patients who underwent lobectomy,wedge resection and segmental resection(all P<0.05).Postoperative pathological classification was the impact factor of wedge or lobectomy(P=0.002),and preoperative imaging stage was the impact factor of segmental or lobectomy(P=0.033)for stageⅠA NSCLC in the right upper lobe.Conclusion Preoperative imaging stage and postoperative pathological classification were impact factors of the choice of surgical methods for stageⅠA NSCLC in the right upper lobe.