可手术非小细胞肺癌对侧纵隔和斜角肌前淋巴结转移的临床研究  

Evaluation of lymph node metastasis in the contralateral mediastinum or scalene through mediastinoscopy and para-mediastinal small incision in potentially operable non-small cell lung cancer

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]汕头市中心医院肿瘤外科,广州515031510060 [2]中山大学肿瘤防治中心胸外科,广州510060 [3]中山大学肿瘤防治中心影像介入中心

出　　处：《中华肿瘤杂志》2007年第8期629-631,共3页Chinese Journal of Oncology

摘　　要：目的探讨适合行病灶对侧纵隔、斜角肌前淋巴结活检的可手术非小细胞肺癌患者的临床特征。方法89例Ⅰ～ⅢA期非小细胞肺癌患者开胸术前行经颈纵隔镜检查,12例联合右斜角肌活检术,10例联合前纵隔切开术。结果纵隔镜检查后发现9例为不可手术患者,其中3例为右斜角肌淋巴结转移(N3),6例为病灶对侧纵隔淋巴结转移(N3)。统计学分析显示,肺腺癌组的N3发生率高于非腺癌组(P<0.05),血清CEA水平升高组的N3发生率高于正常组(P<0.05),同侧纵隔淋巴结多站转移组的N3发生率高于同侧单站转移组(P<0.05)。结论对可手术的肺腺癌、血清CEA升高、病灶同侧纵隔淋巴结多站转移患者应行病灶对侧或斜角肌前淋巴结活检,以排除N3病变。Objective The purpose of this study was to investigate the clinical characteristics of lymph node metastasis in the contralateral mediastinum and scalene in patients with potentially operable non- small cell lung cancer （NSCLC）. Methods Cervical mediastinoscopy was performed for 89 patients with clinical stage I - Ⅲ A non-small cell lung cancer prior to thoracotomy. Of these, 12 underwent cervical medistinoscopy combined with right scalene lymph node biopsy and 10 with anterior para-mediastinal small incision. Results A total of 9 patients were found have N3 disease on mediastinosopy, with cancer-cell- positive lymph nodes in the contralateral mediastinum in 6 and 3 in the right scalene. Statistical analysis revealed that the incidence of N3 disease in adenocarcinoma group was higher than that in patients with non- adenocarcinoma（ P 〈0.05）, which was also higher in the patients with serum CEA 〉 5 ng/ml than that in the patients with CEA 〈5 ng/ml（P 〈 0.05 ）, and it was higher in the patients with ipsilateral mediastinal multi-station lymph node metastasis than that in the patients with uni-station lymph node metastasis （ P 〈 0.05）. Conclusion Biopsy of contralateral mediastinal lymph nodes or scalene lymph node should be performed in order to exclude N3 disease for potentially operable NSCLC patients with ad serum CEA 〉 5 ng/ml or ipsilateral muhi-station mediastinal lymph node metastasis.

关 键 词：肺肿瘤 纵隔镜检查 新辅助化疗 

分 类 号：R734.2[医药卫生—肿瘤]