术中多普勒超声结合术前CT指导清扫非小细胞肺癌淋巴结的临床应用  

Application of Dopple ultrasonography combined with preoperative CT to guild lymph node dissection in non-small-cell lung cancer patients

作　　者：罗清泉[1] 陶巨蔚[1] 丁文龙[2] 赵晓菁[1] 林皓[1] 丁正平[1] 周允中[1] 

机构地区：[1]上海交通大学附属上海胸科医院上海市肺部肿瘤临床中心超声科,上海200030 [2](上海交通大学医学院解剖教研室,上海200025

出　　处：《中国癌症杂志》2007年第2期155-159,共5页China Oncology

摘　　要：背景与目的:肺癌是目前最常见的恶性肿瘤,外科手术是治疗非小细胞肺癌的重要手段,淋巴结清扫是肺癌规范化手术的关键步骤之一,其中包括淋巴结清扫的数量和范围,它也是预防复发和减少转移的关键措施;淋巴结清扫对肺癌患者术后生存期和进行TNM分期、指导术后治疗有重要意义。纵隔内器官和软组织是超声检查的理想介质,术中超声有助于发现纵隔内较小的转移淋巴结,并根据淋巴结的超声影像学表现,结合术前CT对淋巴结进行清扫,减少清扫淋巴结时不必要的创伤。本研究旨在探讨彩色多普勒超声结合术前CT及术后病理指导清扫非小细胞肺癌淋巴结的临床意义;并了解超声下纵隔淋巴结的声像特征和淋巴结转移特点。方法:选择2005年10月—2006年7月上海市胸科医院胸外科住院并经手术治疗的66例非小细胞肺癌患者。平均年龄62岁;所有66例患者均在全麻下双腔气管插管单肺通气下完成手术。所有病例术前常规胸部CT检查,均作系统性淋巴结清扫,在清扫淋巴结之前用多普勒超声对纵隔淋巴结进行检查并同术前CT进行对比,术后病理检查腺癌36例,鳞癌30例;淋巴结转移者行免疫组化检查。检查范围:右侧包括1、2、3、4、7、9组淋巴结,左侧包括5、6、7、9组淋巴结。右侧36例肺癌其中上叶24例、下叶9例、中叶3例,左侧30例肺癌其中上叶16例、下叶14例;术中总共清扫淋巴结390枚,其中转移淋巴结140枚。术前CT下TNM分期cT2N0M016例,cT2N1-2M050例;术后TNM分期:pT2N0M036例,pT2N2M030例。结果:圆形类圆形暗回声、边界清楚和扁平、边界不清楚的检出率为87.5%;CT下淋巴结大于1 cm的阳性符合率为84.3%,多普勒超声检查显示圆形和类圆形且伴有暗回声的阳性诊断率为67%,扁平边界不清楚者的阴性符合率为100%。腺癌较鳞癌容易发生2组以上的淋巴结转移。多普勒超声与CT阳性符合率为84.3Background and purpose： Pulmonary carcinoma is one of the most common cancers world wide. Mediastinal lymph node dissection, including the number and area, is indispensable to the treatment of lung cancer. It is important to achieve better treatment outcome, obtain pathologic staging and guide post-operative treatment for non-small cell lung cancer patients. This study was to explore the significance of Doppler uhrasonography combined with pre-operative CT to guide lymph node dissection in non-small cell lung cancer patients. Methods： 66 histologically confirmed non-small cell lung cancer patients, admitted in the Department of Thoracic Surgery, Shanghai Chest Hospital, from October 2005 to July 2006 were included in this study. The mean age of the patients was 62 years. All patients had preoperative computed tomographic scan, intra-operative Doppler uhrasonography evaluation followed by systemic mediastinal lymph node dissection. Dopple uhrasonography evaluation included station 1,2, 3,4, 7, 9 for right lung cancer, and 5,6, 7, 9 for left lung cancer. 36 masses were located in the left lung , with 24 patients in upper lobe, 3 in middle lobe and 9 in lower lobe. 30 masses were located in the right lung, with 16 patients in upper lobe and 14 in lower lobe, respectively. 16 patients were clinically T2N0M0, and 50 were cT2N1-2M0 as shown by preoperative CT; 36 patients were T2N0M0, and 30 were T2N, M0 according to pathologic TNM staging. A total of 390 lymph nodes were removed in this study, and 140 lymph nodes contained metastatic disease. Results： The lymph nodes larger than 1 cm as shown by CT were defined as malignant. The ultrasound feature of malignant lymph nodes included circular lesion , regular margin with low echotexture. Positive predictive rate of pre-operative CT and intra-operative Doppler ultrasonography was 84.3% and 67%, respectively. The patients with adenocarcinoma were more likely to have metastasis in muhiple-station lymph nodes than those with squamous cell carcinoma. Condusions： The c

关 键 词：肺肿瘤 非小细胞肺癌 术中多普勒超声 术前CT 淋巴结清扫 

分 类 号：R730.41[医药卫生—肿瘤]