非小细胞肺癌N3组淋巴结行纵隔镜探查活检指征的探讨  

The clinical screening indication of N3 lymph node biopsy performed at mediastinoscopy in NSCLC

作　　者：余辉[1] 张仕义[2] 王欣[1] 谢泽明[1] 王军业[1] 李涌[1] 谢绚[1] 周佳亮[1] 张兰军[1] 傅剑华[1] 

机构地区：[1]中山大学肿瘤防治中心胸科华南肿瘤学国家重点实验室,广州510060 [2]汕头市中心医院肿瘤外科,515031

出　　处：《临床肿瘤学杂志》2009年第4期319-322,共4页Chinese Clinical Oncology

摘　　要：目的:探讨和筛选出对非小细胞肺癌(NSCLC)N3组淋巴结需行纵隔镜探查活检的临床指征。方法:89例Ⅰ～ⅢA期NSCLC患者开胸术前行经颈纵隔镜检查,其中12例联合右斜角肌活检术、10例联合前纵隔切开术检查N3组淋巴结的病理状况。结果:纵隔镜检查后共发现9例为不宜再行开胸手术患者,其中3例为右斜角肌淋巴结转移,6例为病灶对侧纵隔淋巴结转移。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:肺腺癌、血清CEA升高和病灶同侧纵隔淋巴结多站转移的NSCLC,推荐行病灶对侧或斜角肌前淋巴结活检,以排除N3病变,为最优化的多学科治疗提供依据。Objective：The purpose of this study was to explore the clinical screening indication of N3 lymph node biopsy performed at mediastinoscopy in non-small cell lung cancer（NSCLC）.Methods：Cervical mediastinoscopy was performed for 89 patients with clinical stage Ⅰ-ⅢA non-small cell lung cancer prior to thoracotomy,and 12 cases underwent cervical medistinoscopy combined with right scalene lymph node biopsy and 10 cases combined with anterior mediastinotomy.Results：A total of 9 cases were found tumor-positive lymph nodes on mediastinosopy with N3 disease.In 9 cases of N3 disease were found in this group,6 cases were contralateral mediastinal lymph nodes metastasis and 3 cases were right scalene lymph node metastasis.Statistical analysis revealed the incidence of the N3 disease in adenocarcinoma group was higher than that in patients with non-adenocarcinoma（P〈0.05）,the incidence of the N3 disease in patients with serum CEA〉5ng/ml was higher than that in patients with CEA〈5ng/ml（P〈0.05）,the incidence of the N3 disease in patients with ipsilateral mediastinal multi-station lymph nodes metastasis was higher than that in patients ipsilateral mediastinal uni-station lymph nodes 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 adenocarcinoma,serum CEA〉5ng/ml and ipsilateral multi-station mediastinal lymph nodes 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]