煤工尘肺并发肺癌淋巴结纤维化对手术的影响  

Impact of coal workers＇ pneumoconiosis complicated by lymph node fibrosis in lung cancer on surgical treatment

作　　者：石爱群[1] 游宾[2] 霍成[1] 连亚莉[1] 赵元生[1] 许智华[1] 姜永全[1] 王勇[1] 李辉[2] 

机构地区：[1]大同煤矿集团公司总医院心胸外科,037003 [2]首都医科大学附属北京朝阳医院胸外科

出　　处：《中华劳动卫生职业病杂志》2016年第5期374-376,共3页Chinese Journal of Industrial Hygiene and Occupational Diseases

摘　　要：目的探讨煤工尘肺并发肺癌淋巴结的病理改变对手术治疗的影响。方法将63例接受肺叶切除加系统性纵隔淋巴结清扫术的非小细胞肺癌患者分为煤工尘肺并发肺癌组30例，非尘肺肺癌组33例。比较两组病例手术近期效果，并与术后病理淋巴结纤维化相印证，同时分析胸部CT淋巴结肿大对手术近期效果的预测价值。结果与非尘肺肺癌组比较，煤工尘肺并发日市癌组手术时间、术中出血量、术后拔管时间和住院时间等各观察指标均明显增加，差异有统计学意义（P〈0．05）。按淋巴结纤维化与否分组，淋巴结纤维化组手术耗时和术中出血量均明显高于无淋巴结纤维化组，差异有统计学意义（P〈0．05）。结论煤工尘肺并发肺癌时，由于淋巴结的严重纤维化往往导致手术困难，开胸手术可能是一种更加安全、有效地治疗方法。Objective To investigate the impact of coal workers＇ pneumoconiosis complicated by the pathological changes in lymph nodes in lung cancer on surgical treatment. Methods A total of 63 patients with non-small cell lung cancer who received pulmonary lobectomy and systemic mediastinal lymph node dissection were enrolled and divided into the group with coal workers＇ pneumoconiosis complicated by lung cancer （30 patients） and the non-pneumoconiosis liver cancer group （33 patients）. The short-term outcome was compared between the two groups and confirmed by lymph node fibrosis shown by postoperative pathological examination. The predictive value of lymphadenectasis on chest CT was analyzed. Results Compared with the nonpneumoconiosis liver cancer group, the group with coal workers＇ pneumoconiosis complicated by lung cancer had significant increases in time of operation, intraoperative blood loss, postoperative extubation time, and length of hospital stay （P〈0.05）. The patients were divided into groups according tO the presence or absence of lymph node fibrosis, and the group with lymph node fibrosis had a significantly longer time of operation and greater intraoperative blood loss than the group without lymph node fibrosis （P〈0.05）. Conclusion When coal workers＇ pneumoconiosis is complicated by lung cancer, severe lymph node fibrosis often causes difficulties in surgery, and thoracotomy may be a safe and effective therapeutic method.

关 键 词：尘肺 肺肿瘤 淋巴结 

分 类 号：R135.2[医药卫生—劳动卫生] R734.2[医药卫生—公共卫生与预防医学]