术前纵隔镜检查对非小细胞肺癌纵隔淋巴结转移的预测价值分析  

Evaluation of preoperative mediastinoscopy on of mediastinal lymph nodes metastases in patients with nonsmall cell lung cancer after undergoing mediastinoscopy.

作　　者：张仕义[1] 王欣[2] 戎铁华[2] 郑列[3] 曾灿光[2] 谢泽明[2] 余辉[2] 朱志华[2] 

机构地区：[1]广东省汕头市中心医院肿瘤外科,515031 [2]中山大学肿瘤防治中心胸外科 [3]中山大学影像介入中心

出　　处：《中国综合临床》2007年第11期1010-1012,共3页Clinical Medicine of China

摘　　要：目的探讨非小细胞肺癌纵隔淋巴结转移特点及术前行纵隔镜检查的重要性。方法89例临床诊断Ⅰ～Ⅲa期非小细胞肺癌患者接受纵隔镜检查;纵隔镜检查阴性者行开胸手术肺叶切除、系统纵隔淋巴结清扫,纵隔镜检查病灶同侧纵隔淋巴结转移(N2)者行新辅助化疗,病灶对侧纵隔或斜角肌淋巴结转移(N3)者行放化疗。结果纵隔镜检查共发现23例N2、9例N3患者。右肺癌主要转移至右侧第2(R2)、第4(R4)、第7(R7)、右斜角肌(RS)站淋巴结,左肺癌主要转移至5、6、7站淋巴结,但左下肺癌也可转移至R2、R4和RS站。本组左、右肺癌对侧纵隔淋巴结转移率比较差异无统计学意义(P=0.219)。多因素分析结果显示CT扫描纵隔淋巴结短径≥1cm是预测纵隔淋巴结转移的一个独立因素。结论可手术非小细胞肺癌患者术前行纵隔镜检查可提高分期准确性,减少不必要的开胸手术。Objective To investigate the characteristics of mediastinal lymph nodes metastases in patients with non-small cell lung cancer （ NSCLC ） and to explore the significance of mediastinoseopy in patients with potentially operable NSCLC before anrgery. Methods Mediastinoseopy was performed in 89 patients with clinical stage Ⅰ - Ⅲ a non-small cell lung cancer. The patients who presented tumor-negative lymph nodes on mediastinoseopy underwent thoraeotomy for lobeetomy of lung and systemic mediastinal lymph node dissection. Mediastinoseopy-verified N2 eases treated with neoadjuvant chemotherapy, and mediastinoseopy-verified N3 eases only received radioehemo- therapy. Results A total 32 of 89 eases were found tumor-positive lymph nodes on mediastinosopy,ineluding 23 eases with N2 and 9 cases with N3. Regarding tumors originating in the right lung mainly metastasized to. R2, R4, R7 and RS （right scalene ）, and tumors originating in the left lung mainly metastasized to R5, R6, R7, while tumors of the left lower lobe could also spread to R2, R4 and RS. There was no statistical difference （ P = 0. 219 ） in the incidence of involving of the eontralateral mediastinal lymph nodes（MLNs ） between patients with primary tumors in the left side and those in the right side. Multivariate analysis showed MLNs shortest diameter over 1.0cm on CT scan was the only independent factor to predict MLNs metastasis. Conclusion Mediastinoseopy might improve the accurately preoperative staging of potentially operable NSCLC and reduce unnecessary thoraeotomy.

关 键 词：非小细胞肺癌 纵隔镜 新辅助化疗 

分 类 号：R734.2[医药卫生—肿瘤]