非小细胞肺癌肺内淋巴结规范化清扫的临床研究（附234例报告）

发布时间：2019-07-04 20:23

【摘要】：背景与目的非小细胞肺癌(NSCLC)切除术中规范化淋巴结清扫具有重要意义。根据UICC及AJCC的推荐,NSCLC淋巴结可分为第一站(N1)及第二站(N2),其中第一站淋巴结包括肺门(No10)、叶间(No11)、叶支气管旁(No12)、段支气管旁(No13)及亚段支气管旁(No14)。而第13及第14组淋巴结又被称为肺内淋巴结(Intrapulmonary lymph node,ILN)。在临床实际工作中通常对ILN的清扫及送检未予以足够重视,本研究旨在研究NSCLC切除术中规范化肺内淋巴结清扫的临床价值。方法收集2013年1月至2015年12月间在重庆医科大学附属第一医院胸外科同一手术组连续接受根治性手术切除的234例原发性周围型NSCLC患者,当病肺切除以后,术者以组织剪沿支气管树进行解剖,对相关区域淋巴结(即No12、No13、No14)逐一剪下、分袋储存并标记送病理学检查。手术中对纵隔淋巴结同时行系统性清扫。结果共清扫N1淋巴结3019枚,平均每例12.90枚,其中转移263枚,转移率为8.71%。跳跃性N2转移患者11例(4.70%)。常规病理检测无N2及N1淋巴结转移者共135例(57.69%)。检出第13或/和第14组淋巴结转移的患者16例,占6.84%。N1淋巴结阳性患者中,No10、No11、No12、No13、No14淋巴结转移阳性率分别为2.69%,10.51%,9.83%,10.43%,8.48%。若不清扫No13及No14,N1转移漏诊率达6.84%(16/234)。结论术中肺内淋巴结的规范清扫有助于发现可能漏诊淋巴结转移,这将对原发性NSCLC的准确分期和术后辅助治疗方案的选择有重要意义。
[Abstract]:Background and objective standardized lymph node dissection in (NSCLC) resection of non-small cell lung cancer is of great significance. According to the recommendation of UICC and AJCC, NSCLC lymph nodes can be divided into the first station (N1) and the second station (N2). The first stage lymph nodes include hilar (No10), interlobar (No11), paratobronchial (No12), segmental bronchus (No13) and subsegmental bronchus (No14). The 13th and 14th groups of lymph nodes are also known as intrapulmonary lymph nodes (Intrapulmonary lymph node,ILN). In clinical practice, insufficient attention has been paid to the cleaning and examination of ILN. The purpose of this study was to study the clinical value of standardized intrapulmonary lymph node dissection in NSCLC resection. Methods from January 2013 to December 2015, 234 patients with primary peripheral NSCLC underwent radical resection in the same operation group, the first affiliated Hospital of Chongqing Medical University. After pneumonectomy, the patients were dissected along the bronchial tree, the lymph nodes (i.e. No12,No13,No14) in the related areas were cut off one by one, stored in bags and marked for pathological examination. The mediastinal lymph nodes were systematically cleaned at the same time during the operation. Results A total of 3019 N1 lymph nodes were removed, with an average of 12.90 lymph nodes per case, of which 263 were metastases, the metastasis rate was 8.71%. There were 11 patients (4.70%) with jump N2 metastasis. 135 cases (57.69%) had no N _ 2 and N _ 1 lymph node metastasis by routine pathology. Among the 16 patients with lymph node metastasis in group 13 or / and group 14, the positive rates of No10,No11,No12,No13,No14 lymph node metastasis were 2.69%, 10.51%, 9.83%, 10.43% and 8.48%, respectively. The missed diagnosis rate of No13 and No14,N1 without cleaning was 6.84% (16 / 234). Conclusion the standard cleaning of intraoperative pulmonary lymph nodes is helpful to detect the possible missed diagnosis of lymph node metastasis, which will be of great significance for the accurate staging of primary NSCLC and the choice of postoperative adjuvant treatment.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R734.2

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