摘要
目的观察临床Ⅰ期(cⅠ期)直径≤3 cm非小细胞肺癌(Non-small-cell lung cancer,NSCLC)患者根治性手术中淋巴结清扫的临床特点,并提出淋巴结清扫方式建议。方法选取130例cⅠ期并且直径≤3 cm原发性NSCLC患者资料,均接受根治性手术治疗,分析淋巴结转移与临床特点的关系,予以淋巴结清扫方式建议。结果130例患者术后并发症发生率16.15%(21/130),无死亡。ⅠA期~ⅠB期、ⅡA期、ⅡB期、ⅢA期、ⅢB期淋巴结转移率分别为0.00%(0/50)、73.33%(11/15)、0.00%(0/1)、20.63%(13/63)、100.00%(1/1),差异有统计学意义(P<0.05)。P-GGO、结节直径≤1 cm、结节直径>1~2 cm、结节直径>2~3 cm淋巴结转移率分别为0.00%(0/23)、12.50%(2/16)、22.22%(14/63)、32.14%(9/28),差异有统计学意义(P<0.05);结节直径≤1 cm与结节直径>1~2 cm淋巴结转移率比较无明显差异(P>0.05)。P-GGO、混合型、实性结节型淋巴结转移率分别为0.00%(0/18)、4.17%(1/24)、27.27%(24/88),差异有统计学意义(P<0.05);右肺上叶癌、右肺下叶癌、左肺上叶癌特异性引流区淋巴结阳性组与阴性组非特异性引流区淋巴结转移率(66.67%vs 0.00%、50.00%vs 0.00%、50.00%vs 0.00%)比较差异有统计学意义(P<0.05)。结论P-GGO病变的早期NSCLC通常无淋巴结转移现象,可不采取系统性淋巴结清扫措施;结节型NSCLC患者淋巴结转移率会在病灶直径(特别是实性结节)增大时随之升高,结节直径≤2 cm时,可先对其特异性引流区淋巴结进行清扫同时冰冻病理检查,显示阳性则需进行系统性淋巴结清扫,显示阴性则可考虑不对非特异性引流区予以系统性淋巴结清扫。
Objective To observe the clinical features of lymph node dissection in radical operation for non-small cell lung cancer(NSCLC)at clinical stageⅠ(stage cⅠ)and with diameter≤3 cm,and to propound recommended ways for lymph node dissection.Methods The data of 130 patients with primary NSCLC at stage cⅠand with diameter≤3 cm were selected.All patients underwent radical operation.The relationship between lymph node metastasis and clinical features was analyzed.Ways for lymph node dissection were recommended.Results The incidence of postoperative complication in the 130 patients was 16.15%(21/130),without death.The lymph node metastasis rates at stageⅠA toⅠB a,ⅡA,ⅡB,ⅢA andⅢB were 0.00%(0/50),73.33%(11/15),0.00%(0/1),20.63%(13/63)and 100.00%(1/1),respectively(P<0.05).The lymph node metastasis rates of P-GGO,nodules diameter of or less than 1 cm,nodules diameter between 1 cm and 2 cm(including 2 cm)and nodules diameter between 2 cm to 3 cm(including 3 cm)were 0.00%(0/23),12.50%(2/16),22.22%(14/63)and 32.14%(9/28),respectively(P<0.05).There was no significant difference in the lymph node metastasis rate between the nodules diameter of or less than 1cm and nodules diameter between 1cm and 2cm(including 2 cm)(P>0.05).The lymph node metastasis rates of P-GGO,mixed type and solid nodular type were 0.00%(0/18),4.17%(1/24)and 27.27%(24/88),respectively(P<0.05).The lymph node metastasis rates of right upper lobe lung cancer,inferior lobe of right lung cancer and upper lobe of left lung in specific drainage area and non-specific drainage area of lymph node positive group and negative group were as followed(66.67%vs 0.00%,50.00%vs 0.00%,50.00%vs 0.00%)(P<0.05).Conclusion There is usually no lymph node metastasis in the early NSCLC of P-GGO lesions.The measure of systemic lymph node dissection may not be taken.The lymph node metastasis rate of patients with nodular NSCLC will increase when the diameter of the lesion(especially solid n-odules)increases.When the diameter of the nodule is of or less than 2cm,the lymph node of the specific drainage area can be cleaned and at the same time the pathological examination is frozen.If the status is positive,the systemic lymph node dissection should be performed.If the status is negative,the systemic lymph node dissection should not be considered for the non-specific drainage area.
作者
马国锋
王华川
MA Guofeng;WANG Huachuan(Dazhou Central Hospital,Dazhou,635000)
出处
《实用癌症杂志》
2020年第3期414-417,共4页
The Practical Journal of Cancer
关键词
非小细胞肺癌
根治性手术
淋巴结
清扫方式
Non-small cell lung cancer
Radical operation
Lymph node
Dissection way
