【作者】 杨波；

【导师】 崔永生；

【作者基本信息】 吉林大学 ， 外科学（专业学位）， 2015， 硕士

【摘要】 目的：比较早期非小细胞肺癌的两种不同纵隔淋巴结手术清扫方式间的差异，为了规范的开展早期非小细胞肺癌淋巴结清扫的临床研究提供依据。方法：选择从2012年3月至2014年6月间行肺叶切除术的122例非小细胞肺癌患者，术前均经CT和（或）PET-CT进行淋巴结（lymph node，LN）分期评估为N0/N1，对122例非小细胞肺癌(non-small-cell lung cancer，NSCLC)患者进行临床对照试验，比较系统性淋巴结清扫（complete systematic lymph node dissection，CSLND）和选择性淋巴结清扫（selective lymph node dissection，SLND）两种手术术式，并详细记录了淋巴结的清扫情况，对纵隔淋巴结的转移频率及转移方式进行总结，同时对行SLND和CSLND的NSCLC患者的复发和生存率进行比较。结果：从2012年3月至2014年6月之间行肺叶切除术的122例非小细胞肺癌患者中，CSLND组82人，SLND组40人，在CSLND组中，有11人（13.4%）经术后病理证实存在N2转移，病理为腺癌的NSCLC患者较其他病理类型的患者出现N2转移的机率更大（p=0.02）。仅有一位患者（1.2%）术后经病理证实出现了跳跃性N2转移。CSLND与SLND两组患者在术后复发率（19.5%vs20.0%,p=0.95）、随访期内死亡率（22.0%vs15.0%,p=0.37）、无瘤生存期（p=0.92）及总体生存率（p=0.31）上无统计学差异。结论：对于术前经CT和（或）PET-CT检查诊断为N2阴性的NSCLC患者，依据其肿物所在特定肺叶，其LN的转移机率及方式具有一定的可预见性。SLND与CSLND在患者术后的复发率及长期存活率上无统计学差，对于早期NSCLC，病理类型为非腺癌的患者，SLND是可为胸外科临床医师所接受的术式。更多还原

【Abstract】 Obiective:To evalute the results of two styles of mediastinal nodal dissection for early non-small-cell lung cancer(NSCLC).Methods:Patients with clinical N0/N1nonsmall-cell lung cancer（NSCLC） staged with CT scans and (or) PET scans who have underwent lobectomy between March2012and June2014were identified.Disease involvement of resected nodal stations was recorded,the purpose of which is to conclude the metastasis frequency and pattern of mediastinal nodal. In addition,the long-term outcome of thepatients who underwent lobectomy with complete systematic lymphnode dissection(CSLND) were compared with those who underwentselective lymph node dissection(SLND).Results:From March2012to June2014,122patients were identified.CSLND was performed in82patients,SLND was performed in40patients.11patients(13.4%) in the group with CSLND were found tohave N2disease after pathologic evaluation.Patients with adenocarcinoma were more likely to have pathologic N2disease than were p atients with other pathology.Only one patient (1.2%) had positive N2disease in the distal mediastinum while skipping lobe-specfic mediastinal nodes.Furthermore,patients with SLND had a similar rate ofrecurrence（19.5%vs20.0%,p=0.95),mortality（22.0%vs15.0%,p=0.37),disease-free survival（p=0.92）and overall survival（p=0.31).Conclusion:Mediastinal N2metastases follow predictable lobe-specfic patterns in patients with negative preoperative CT scans and PET scans.SLND results in a similar rate of recurence and overall survival to that of CSLND. SLND appears acceptable in patients with early-stage NSCLC whose pathological type is not glandular cancer.更多还原