摘要
目的 通过对周围型小肺癌的TNM分期进行分析,以提高临床医师对恶性肺小结节的重视,并探讨小肺癌系统性淋巴结清扫的必要性.方法 回顾性分析2005年1月至2013年6月99例行肺叶切除术＋系统性淋巴结清扫术的周围型小肺癌患者的临床资料,肿瘤及所有淋巴结均获得病理证实,然后进行TNM分期,分析各组淋巴结的转移情况,肿瘤T分期、淋巴结大小与淋巴结转移的关系.结果 病理T分期：T1a期71例（71.72%）,T2a期28例（28.28%）.22例患者有淋巴结转移（22.22%）,其中N1 12例（12.12%）、N2 10例（10.10%）.TNM分期：Ia期58例（58.59%）,Ib期18例（18.18%）,≥Ⅱa期者23例（23.23%）.共清扫胸内淋巴结1226枚,平均每例12.38枚,126枚淋巴结存在癌转移（10.28%）.T2a期淋巴结转移率明显高于T1a期（P＜0.05）.淋巴结直径0.5～1.0cm的转移率高于直径＜0.5cm者,但差异无统计学意义（P＞0.05）.结论 周围型小肺癌并不完全是早期肺癌,约1/4患者为≥Ⅱ期的中、晚期肺癌.对小肺癌患者进行系统性淋巴结清除术非常必要,不能以术中未触及肿大淋巴结而排除淋巴结的清扫.
Objective To increase clinical doctors＇attention to malignant small pulmonary nod- ules and discuss the necessity of systematic lymphadenectomy for small lung cancer by analyzing TNM staging of small peripheral lung cancer. Methods The clinical data of 99 patients with peripheral small lung cancer who underwent pulmonary lobectomy and systematic lymphadenectomy from January 2005 to June 2013 were retrospectively analyzed. All of tumors and lymph nodes were diagnosed by pathology. All cases received TNM staging and analyzed for metastasis of lymph nodes. The relationships among T stage, lymph node size and metastatic rate were studied. Results Confirmed by postoperative pathological exami- nation,71 cases were stage Tla（71.72% ） and 28 were stage T2a（28.28% ）. Twenty-two cases were con- firmed as lymph node metastases（22.22% ）and the numbers of patients with nodal metastases of N1 and N2 were 12 and 10,respectively. Of 99 patients with peripheral small lung cancer,58 were in early stage Ⅰ a lung cancer （58.59%）, 18 in stage Ⅰ b （ 18.18 % ）, and 23 above stage Ⅱ a （ 23.23 % ）. The total number of resected thoracic lymph nodes was 1226, and the mean number of dissected lymph nodes was 12.38 in each patient. There were 126 lymph nodes with metastases and the metastatic rate of lymph nodes was 10.28%. The metastatic rate of lymph nodes in patients with stage T2a was obviously higher than that in patients with stage T1 a（ P 〈 0.05）. The metastatic rate of lymph node in Group B （0.5-1.0 cm）was higher than that in group A（ 〈 0.5 cm）, but there was not significant difference（ P 〉 0.05 ）. Conclusion Peripheral small lung cancer is not entirely early lung cancer, and about a quarter of patients are above stage Ⅱ which meant that their diseases were at advanced stages. It is really necessary for the patients with small lung cancer to be underwent systematic lymphadenectomy, even no enlarged lymph nodes are touched during the operation.
出处
《临床外科杂志》
2014年第1期49-52,共4页
Journal of Clinical Surgery
