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目的探讨原发性周围型小肺腺癌(直径≤3cm)淋巴结转移的规律,为治疗方案的制定提供参考。方法自1990年1月至2009年1月期间,首都医科大学附属北京友谊医院胸外科手术治疗肿瘤最大直径(CT测量)≤3 cm的周围型原发性肺腺癌288例,其中男223例,女65例;年龄30~73岁。288例患者诊断均经病理检查证实,临床诊断淋巴结转移的标准为最小直径大于1.0 cm(CT)。手术方式:肺叶切除术264例,肺袖式切除术22例,肺楔形切除术2例;纵隔淋巴结清扫方式为系统纵隔淋巴结清扫或采样。结果 288例中发生淋巴结转移142例(49.30%),其中术后分期为N190例(31.25%),N252例(18.06%)。不同原发部位的淋巴结转移率:右肺46.67%(77/165),左肺56.10%(69/123);肿瘤直径小于1 cm者淋巴结转移率为22.22%(2/9),1~2 cm之间者为39.44%(28/71),2~3 cm之间者为53.84%(112/208),三者间比较差异有统计学意义(P<0.01)。直径小于1 cm者未发现N2转移,1~2 cm之间者N2阳性率为14.08%(10/71),2~3 cm之间者N2阳性率为20.19%(42/208),三者间比较差异有统计学意义(χ2=20.01,P<0.01)。结论周围型小肺腺癌肺门及纵隔淋巴结转移常见,尤其是右肺上叶肺癌。直径大小对腺癌淋巴结转移发生率有明显的影响,但即便直径小于2 cm,淋巴结转移仍有很大的风险。术前应尽可能获得准确的N分期,如不能在术前确定N分期,对直径1 cm以上的肺腺癌术中应常规进行纵隔淋巴结清扫,否则难以获得准确的分期,亦难以达到根治性切除。
Objective To investigate the regularity of lymph node metastasis in primary peripheral lung adenocarcinoma (diameter≤3cm) and to provide a reference for the development of treatment regimen. Methods From January 1990 to January 2009, 288 cases of peripheral primary pulmonary adenocarcinoma with a maximum tumor diameter (CT) ≤3 cm were treated by Department of Thoracic Surgery, Beijing Friendship Hospital Affiliated to Capital University of Medical Sciences. Among them, 223 cases were male , 65 females; aged 30 to 73 years. 288 cases of patients diagnosed by pathological examination confirmed the clinical diagnosis of lymph node metastasis criteria for the smallest diameter greater than 1.0 cm (CT). Surgical procedures: 264 cases of lobectomy, lung sleeve resection in 22 cases, lung wedge resection in 2 cases; mediastinal lymph node dissection for the system of mediastinal lymph node dissection or sampling. Results There were 142 cases (49.30%) of lymph node metastasis in 288 cases, of which N190 cases (31.25%) and N252 cases (18.06%) were postoperative staging. The rate of lymph node metastasis in different primary sites was 46.67% (77/165) in the right lung and 56.10% (69/123) in the left lung. The rate of lymph node metastasis was 22.22% (2/9) in tumors less than 1 cm in diameter and 1-2 cm and 39.44% (28/71) respectively. The difference between the two groups was 53.84% (112/208). The difference was statistically significant (P <0.01). No N2 metastasis was found when the diameter was less than 1 cm, the positive rate of N2 between 1 ~ 2 cm was 14.08% (10/71), and the positive rate of N2 between 2 ~ 3 cm was 20.19% (42/208) The difference was statistically significant (χ2 = 20.01, P <0.01). Conclusion Hilar and mediastinal lymph node metastasis of peripheral small lung adenocarcinoma are common, especially in the upper right lung and lung. Diameter has a significant effect on the incidence of lymph node metastasis in adenocarcinoma, but even if the diameter is less than 2 cm, there is still a great risk of lymph node metastasis. Accurate N staging should be obtained before surgery. If N staging can not be determined preoperatively, mediastinal lymph node dissection should be performed routinely in patients with lung adenocarcinoma more than 1 cm in diameter. Otherwise, it is difficult to obtain accurate staging and it is difficult to achieve radical resection.