摘要
目的探究直径≤2 cm周围型非小细胞肺癌(NSCLC)淋巴结转移特点及临床意义;探究区域性纵隔淋巴结清扫的可能性。方法收集我院2017年1月至2018年8月所有结节≤2 cm行肺部手术NSCLC患者完整资料,既往无其他恶性肿瘤病史,手术方式为肺叶切除、肺段切除或楔形切除,并规范清扫纵隔,根据病理结果及临床特征进行综合分析。结果直径≤2 cm的周围型NSCLC淋巴结转移度和转移率均较低(分别为0.67%和1.87%)。直径≤2 cm的纯磨玻璃结节无淋巴结转移、混合磨玻璃结节的淋巴结转移明显低于实性结节(0、1.18%、4.92%)。第11组淋巴结转移与纵隔淋巴结转移(2、3、4、6组)有明显相关性。11组淋巴结转移与结节的实性成分呈正相关(P=0.024),而淋巴结转移与性别、年龄、吸烟史、结节大小、位置及肿瘤类型并无明显相关性。11组淋巴结与2、3、4和6组淋巴结转移明显相关(P=0.014),Kappa值8.406。结论对于纯磨玻璃样病变患者,可不清扫纵隔淋巴结或仅行N1淋巴结采样。对于混合型磨玻璃样病变或实性结节,手术医师可根据术中11组淋巴结冰冻情况决定淋巴结清扫范围,若有转移,则可相对积极,清扫范围适当扩大;如无11组淋巴结转移,可以通过减淋巴结清扫的范围,从而达到减少并发症的目的。
Objective To investigate the characteristics and clinical significance of lymph node metastasis of peripheral non-small cell lung cancer(NSCLC)with diameter≤2 cm;to explore the possibility of regional mediastinal lymphadenectomy.Methods Collect all patients’data with peripheral NSCLC≤2 cm from January 2017 to August 2018 in our hospital,there was no previous history of other malignant tumors.All patients underwent lobectomy,segmentectomy,or wedge resection,and mediastinal lymphadenectomy,and comprehensive analysis was performed based on pathological findings and clinical features.Results Among the peripheral NSCLC with a diameter of≤2 cm,metastatic degree and rate of mediastinal lymph nodes were low(0.67%and 1.87%,respectively).The lymph nodes metastatic rate of pGGO,mGGO and solid nodule were 0,1.18%and 4.92%,respectively.The 11th group of lymph node metastasis was positively correlated with the solid components of lymph nodules(P=0.024).While lymph node metastasis had no significant correlation between gender,age,smoking history,size,location,and tumor type.The metastasis of the 11th group of lymph nodes was positively correlated with the 2nd,3rd,4th and 6th lymph nodes(P=0.014,Kappa value 8.406).Conclusion For the operation of pGGO patients,mediastinal lymphadenectomy was not necessary,or maybe N1 lymph nodes sampling was enough.For the operation of mGGO or solid nodules,the surgeon can determine the lymphadenectomy scope according to the 11th-group lymph nodes frozen pathology result.If positive,the extent of lymph node dissection should be appropriately expanded;If negative,the lymph node dissection can be skipped,so as to reduce the complications.
作者
叶鑫
崔松平
刘毅
游宾
胡滨
李辉
Ye Xin;Cui Songping;Liu Yi;You Bin;Hu Bin;Li Hui(Department of Thoracic Surgery,Beijing Chaoyang Hospital,Affiliated to Capital Medical University,Beijing 100020,China)
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2020年第9期513-517,共5页
Chinese Journal of Thoracic and Cardiovascular Surgery
关键词
肺癌
肺小结节
磨玻璃结节
淋巴结转移
淋巴结清扫
Lung cancer
Pulmonary nodules
Ground-glass nodule
Lymph node metastasis
Lymph node dissection
