恶性肿瘤经治后继发纵隔淋巴结肿大临床分析  

Analysis of mediastinal enlarged lymph node after treatment of malignant tumor

作　　者：崔健 胡晓丹[1] 王晓 赵云 魏秀峰 薛星星 赵洋乐 CUI Jian;HU Xiaodan;WANG Xiao;ZHAO Yun;WEI Xiufeng;XUE Xingxing;ZHAO Yangle(Department of Thoracic Surgery,Chuiyangliu Hospital,Beijing 100021,China)

机构地区：[1]北京市垂杨柳医院胸外科,北京100021

出　　处：《中国当代医药》2023年第17期77-81,共5页China Modern Medicine

摘　　要：目的分析总结恶性肿瘤经治后继发纵隔淋巴结肿大原因,探讨病理在其诊断中的价值。方法回顾性分析2017年6月至2022年8月北京市垂杨柳医院胸外科收治的44例恶性肿瘤经治后继发纵隔淋巴结肿大行经支气管内超声引导纵隔淋巴结针吸活检术患者的临床资料并进行随访。结果患者中男26例,女18例;年龄38~77岁,平均(61.57±8.76)岁。44例患者初治恶性肿瘤为肺癌21例,食管癌11例,乳腺癌8例,鼻咽癌1例,结肠癌1例,肝癌1例,肾癌1例。所有患者均成功行支气管内超声引导纵隔淋巴结针吸活检。病理结果为恶性35例,其中与初治肿瘤病理相同32例,与初治肿瘤病理不同3例,良性9例。根据穿刺病理结果,将患者分为良性病例组和恶性病例组。采用logistic回归模型进行多因素分析,结果显示,症状(β=2.606,OR=13.538,95%CI:1.517~120.849)是发生恶性的独立危险因素(P=0.020)。恶性组的症状构成比高于良性组,差异有统计学意义(P<0.05);两组患者CT影像学表现中淋巴结的数目比较,差异均无统计学意义(P>0.05)。结论恶性肿瘤经治后出现继发纵隔淋巴结肿大临床上容易误诊,病理是纵隔淋巴结肿大确诊的重要手段。Objective Analyze and summarize the causes of secondary mediastinal enlarged lymph node after treatment of malignant tumor,and explore the value of pathology in its diagnosis.Methods From June 2017 to August 2022,the clinical data of 44 patients with mediastinal enlarged lymph node secondary to malignant tumor treated by transbronchial ultrasound guided needle aspiration biopsy of mediastinal lymph nodes in Department of Thoracic Surgery of Chuiyangliu Hospital were retrospectively analyzed and followed up.Results Among the patients,there were 26 males and 18 females.The age ranges from 38 to 77 years old,with an average of(61.57±8.76)years old.The initial malignant tumors of 44 patients were 21 cases of lung cancer,11 cases of esophageal cancer,8 cases of breast cancer cancer,1 case of nasopharyngeal cancer,1 case of colon cancer,1 case of liver cancer,and 1 case of kidney cancer.All patients successfully underwent transbronchial ultrasound guided needle aspiration biopsy of mediastinal lymph nodes.The pathological results showed 35 cases of malignancy,of which 32 cases were the same as the initial tumor pathology,3 cases were different from the initial tumor pathology,and 9 cases were benign.According to the pathological results of puncture,patients were divided into benign case group and malignant case group.Using logistic regression model for multivariate analysis,the results showed that symptoms(β=2.606,OR=13.538,95%CI:1.517-120.849)was an independent risk factor for malignancy(P=0.020).The proportion of symptoms in the malignant group was higher than that in the benign group,and the difference was statistically significant(P<0.05).There was no statistically significant difference in the number of lymph nodes in CT imaging between the two groups of patients(P>0.05).Conclusion Mediastinal enlarged lymph node secondary to malignant tumor after treatment are prone to misdiagnosis in clinical practice,pathology is an important means of diagnosing mediastinal enlarged lymph node.

关 键 词：超声支气管镜 针吸活检术 恶性肿瘤 纵隔淋巴结肿大 多原癌 良性 

分 类 号：R734.2[医药卫生—肿瘤]