【摘要】 目的:探讨非小细胞肺癌患者袖式肺叶切除后切缘阳性(显微镜下可见细胞)的原因、分类及其对预后的影响。方法:回顾分析1998年4月~2013年10月接受支气管袖式肺叶切除的178例患者(男156例,女22例,年龄19~76岁,切缘阳性18例)的生存率,分析手术性质(切缘阴性、切缘阳性),切缘阳性的种类(切缘阳性、切缘周围组织阳性)、病理类型(鳞状细胞癌、非鳞状细胞癌),术后病理分期对预后的影响。结果:中位生存期为112个月,3年和5年生存率分别为69.7%和56.6%。切缘阳性组与切缘阴性组相比,支气管吻合口局部复发率无显著性差异(17%vs 12%,P>0.05),纵隔淋巴结转移(N2)比率显著升高(56%vs 14%,P<0.01),ⅢA期患者比率显著升高(78%vs 35%,P<0.01),5年生存率显著降低(18%vs 60%,P<0.01)。5年生存率在Ⅰ、Ⅱ、ⅢA期患者中分别为81.8%,68.8%,34.4%。多因素分析仅提示高龄和IIIA期为影响5年生存率的危险因素。结论:切缘阳性组长期生存率低的直接原因是病变分期更晚,纵隔淋巴结转移比率更高,而非切缘阳性导致的支气管局部肿瘤复发。术后经放、化疗和气管镜下冷冻综合治疗后,部分患者可以长期生存。更多还原

【Abstract】 Objective:To analyze the reason and prognostic significance of the positive residual disease for non-small cell lung cancer after bronchial sleeve resection.Methods:The survival rates of 178 patients aged from 19 to 76 years(156 male and 22 female)received bronchial sleeve resection from April 1998 to October2013 were analyzed.Eighteen patients were confirmed with positive residual disease.The resection extend(R0 :complete resection and R1:incomplete resection),type of the positive bronchial residual disease(BP:bronchial positive residual disease and PBP:peribronchial positive residual disease), histological classification(squamous cell carcinoma and non squamous cell carcinoma),and postoperative pathology stages were analyzed to determine their impact on the 5-year survival rate.Results:The median survival time was 112 months,the 3- and5-year survival rate was 69.7% and 56.6%.Higher rate of N2 percentage(56%)were found in the positive residual disease compared with negative residual disease(14%)(P<0.01).Higher rate of stage IIIA percentage(78%)were found in the positive residual disease compared with negative residual disease(35%)(P<0.01).There was no significant difference between two groups regarding the anastomotic local recurrence(17% vs 12%,P>0.05).5-year survive rates of stage Ⅰ,Ⅱ,ⅢA were 81.8%,68.8% and 34.4%,respectively(P<0.01).Five-year survive rates of positive residual disease was(18%)much lower than negative residual disease(60%)(P<0.01).Conclusion:The reason of the poor survival rate for the positive residual disease is due to metastatic disease caused by late pathology stage,high percentage of the metastatic mediastinal lymph nodes(N2),rather than local recurrence result from incomplete resection(residual disease).更多还原