肺癌胸腔镜手术淋巴结清扫策略分析(附264例报告)  

Strategy of video-assisted thoracoscopic lymph node eradication for lung cancer:a report of 264 cases

作　　者：杨博[1] 初向阳[1] 戴为民[1] 刘阳[1] 王钰琦[1] 汪涛[1] 赵明[1] 

机构地区：[1]解放军总医院胸外科,北京100853

出　　处：《解放军医学杂志》2013年第9期753-756,共4页Medical Journal of Chinese People's Liberation Army

摘　　要：目的探讨肺癌胸腔镜手术中淋巴结清扫的方法和操作要点。方法对解放军总医院胸外科2007年5月—2012年5月收治的264例肺癌患者行胸腔镜下肺叶切除术。其中右肺手术144例,术中清扫第2、3、4R、7、8、9、10、11组淋巴结,左肺手术120例,术中清扫第5、6、7、8、9、10、11组淋巴结。纵隔淋巴结按解剖区域行en bloc淋巴结清扫。对所有患者的病例资料及术后病理结果进行回顾性分析。结果所有患者均顺利完成手术,手术时间162.4±35.8min,术中出血量129.3±46.3ml。3例患者术后出现乳糜胸,经保守治疗后痊愈。2例患者术后出现声音嘶哑,1例于术后2个月恢复,1例未恢复。右肺手术清扫N1淋巴结8.7±1.2个,N2淋巴结10.6±1.4个;左肺手术清扫N1淋巴结8.2±1.4个,N2淋巴结9.2±1.3个。按解剖区域划分,共清扫右上纵隔淋巴结(含第2、3、4R组)4.2±0.9个,左上纵隔淋巴结(含第5、6组)2.8±1.0个,第7组淋巴结3.3±1.8个,下纵隔淋巴结(含第8、9组)2.1±0.7个。64例(24%)患者有N1淋巴结转移,21例(8%)患者有N2淋巴结转移,其中3例仅有N2淋巴结转移,无N1淋巴结转移。结论肺癌患者行胸腔镜手术时可同时完成淋巴结清扫。按解剖分区行en bloc淋巴结清扫是安全、可靠的方法。Objective To explore the method and essential procedure for lymph node eradication during video-assisted thoracoscopic lobectomy in patients with lung cancer.Methods Two hundred and sixty-four patients with lung cancer underwent thoracoscopic lobectomy and lymph node eradication from April 2007 to April 2012 in General Hospital of PLA.In 144 cases of right lung cancer,the eradicated lymph nodes included groups 2,3,4R,7,8,9,10 and 11.In 120 cases of left lung cancer,the eradicated lymph nodes included groups 5 to 11.The mediastinal lymph nodes were removed en bloc according to the anatomic distribution.The clinical data and pathological results of all patients were analyzed retrospectively.Results The operation was successfully completed in all the patients,the operation time was 162.4±35.8 minutes,and the blood loss was 129.3±46.3ml.Three patients suffered from postoperative chylothorax,and they recovered after conservative treatment.Two patients suffered from the complication of hoarse voice,and one of them recovered 2 months later,and another did not recover.8.7±1.2 and 10.6±1.4 lymph nodes of N1 and N2 were removed in patients with right lung cancer,and 8.2±1.4 and 9.2±1.3 in patients with left lung cancer.According to anatomic distribution,the number of removed lymph nodes from right superior mediastinum（including groups 2,3 and 4R） was 4.2±0.9,that of left superior mediastinum（including groups 5 and 6） was 2.8±1.0,that of inferior mediastinum（including groups 8 and 9） was 2.1±0.7,and that of group 7 was 3.3±1.8.Metastasis of N1 lymph nodes was found in 64 patients（24%） and that of N2 in 21 patients（8%）,and in 3 of them only lymph nodes of N2 were found to have metastasis but none in N1 lymph nodes.Conclusion In video-assisted thoracoscopic lobectomy,lymph node eradication could be accomplished in patients with lung cancer.En bloc lymph node eradication according to anatomic distribution was safe and reliable.

关 键 词：胸外科手术 电视辅助 肺肿瘤 淋巴结切除术 

分 类 号：R734.2[医药卫生—肿瘤]