纵隔镜检查非小细胞肺癌斜角肌前与病灶对侧纵隔淋巴结转移的评价  

Evaluation of scalene lymph node or contralateral mediastinum biopsy during mediastinoscopy for non-small cell lung cancer

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

出　　处：《中华肿瘤杂志》2009年第10期780-782,共3页Chinese Journal of Oncology

摘　　要：目的探讨行纵隔镜检查非小细胞肺癌（NSCLC）斜角肌前淋巴结或病灶对侧纵隔淋巴结转移（N3期）的临床特征。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。结果纵隔镜检查显示，有9例患者不宜再行开胸手术，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期发生率高于非腺癌组（P〈0．05），血清CEA≥5．0ng／ml组的N3期发生率高于〈5．0ng／ml组（P〈0．05），同侧纵隔淋巴结多站转移组的N3期发生率高于同侧单站转移组（P〈0．05）。结论对临床上为腺癌、血清CEA升高、病灶同侧纵隔淋巴结多站转移的NSCLC患者，推荐行病灶对侧纵隔淋巴结、斜角肌前淋巴结活检，以排除N3期病变。纵隔镜检查为NSCLC的多学科治疗提供了依据。Objective To explore the clinical indication of N3 lymph node biopsy during mediastinoscopy for non-small cell lung cancer （NSCLC）. Methods Cervical mediastinoseopy was performed in 89 patients with clinical stage Ⅰ -Ⅲ A non-small cell lung cancer prior to thoracotomy. Of those, 12 underwent cervical medistinoscopy combined with right scalene lymph node biopsy and 10 with anterior mediastinotomy. Resnlts Nine patients were found to have lymph node metastasis （ N3 disease ） during mediastinosopy. Of those, 6 had contralateral mediastinal lymph node metastasis and 3 cases with right scalene lymph node metastasis. The incidence of N3 disease in the patients with adenocarcinoma, serum CEA 〉 5 ng/ml and multi-station mediastinal lymph node metastasis was significantly higher than that in those with non-adenocarcinoma, CEA 〈 5 ng/ml and ipsilateral uni-station mediastinal lymph nodes metastasis （ P 〈 0.05 ）. Conclusion Biopsy of scalene lymph node or contralateral mediastinal lymph node should be performed during mediastinoscopy in order to exclude N3 disease for potentially operable NSCLC patients with adenocarcinoma, serum CEA 〉 5 ng/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：R686[医药卫生—骨科学]