中华胸心血管外科杂志
中華胸心血管外科雜誌
중화흉심혈관외과잡지
Chinese Journal of Thoracic and Cardiovascular Surgery
2012年
2期
86-89
,共4页
陈应泰%黄宇清%李运%金璐明%崔健%刘军%王俊
陳應泰%黃宇清%李運%金璐明%崔健%劉軍%王俊
진응태%황우청%리운%금로명%최건%류군%왕준
肺癌%胸腔镜肺叶切除%临床Ⅰ期%N2阳性%预后
肺癌%胸腔鏡肺葉切除%臨床Ⅰ期%N2暘性%預後
폐암%흉강경폐협절제%림상Ⅰ기%N2양성%예후
Lung cancer%VATS lobectomy%Clinical stage Ⅰ%N2 disease%Prognosis
目的 探讨术后发现病理N2(ⅢA)期非小细胞肺癌全胸腔镜肺叶切除术治疗的疗效.方法 回顾性分析35例(10.1％,35/348例)、接受全胸腔镜肺叶切除术、术前临床分期Ⅰ期而术后意外发现病理N2阳性的非小细胞肺癌患者的临床资料,总结其临床特征、术后短期疗效、复发模式以及中期预后.结果 全组无围手术期死亡.26例直接行肺叶切除,9例先行楔形切除、后行肺叶切除.所有患者完成R0切除,中位手术时间190 min,中位术中出血量200 ml.术中清扫N2站纵隔淋巴结中位4站和10个淋巴结,其中转移阳性中位1站和2个淋巴结,有18例为单站N2淋巴结转移.术后中位胸腔引流8天,中位住院11天.12例出现并发症15例次,均经对症治疗后好转.所有患者按规范接受4个疗程含铂双药方案辅助化疗.患者均随访1 ～55个月,中位值23个月.至随访期末(2011年4月),25例生存,1年和2年总生存率分别为80.9％和67.9％,未达到中位OS.16例患者术后复发,其中局部复发5例,远处转移11例.1年和2年无瘤生存率分别为71.9％和44.2％.中位无瘤生存时间(DFS) 20个月(95％可信区间8.1～31.9个月).将患者按单站或多站N2转移分为两个亚组进行分层分析,结果显示,单站N2阳性和多站N2阳性患者的1年、2年总生存率分别为87.7％、78.9％和67.6％、59.1％.1年、2年无瘤生存率分别为88.9％、49.4％和55.3％、39.5％.中位DFS分别为23个月(95％可信区间8.1～31.9个月)和16个月(95％可信区间2.9～ 29.0个月),单站N2阳性患者的预后好于多站N2阳性患者.结论 对于术前经仔细分期无N2淋巴结转移的NSCLC患者,只要技术可行,应积极行全胸腔镜肺叶切除术,即使术后病理证实存在纵隔N2淋巴结转移,多数也是微小转移或者单站转移,亦可以达到根治手术要求,获得令人满意的疗效.
目的 探討術後髮現病理N2(ⅢA)期非小細胞肺癌全胸腔鏡肺葉切除術治療的療效.方法 迴顧性分析35例(10.1％,35/348例)、接受全胸腔鏡肺葉切除術、術前臨床分期Ⅰ期而術後意外髮現病理N2暘性的非小細胞肺癌患者的臨床資料,總結其臨床特徵、術後短期療效、複髮模式以及中期預後.結果 全組無圍手術期死亡.26例直接行肺葉切除,9例先行楔形切除、後行肺葉切除.所有患者完成R0切除,中位手術時間190 min,中位術中齣血量200 ml.術中清掃N2站縱隔淋巴結中位4站和10箇淋巴結,其中轉移暘性中位1站和2箇淋巴結,有18例為單站N2淋巴結轉移.術後中位胸腔引流8天,中位住院11天.12例齣現併髮癥15例次,均經對癥治療後好轉.所有患者按規範接受4箇療程含鉑雙藥方案輔助化療.患者均隨訪1 ～55箇月,中位值23箇月.至隨訪期末(2011年4月),25例生存,1年和2年總生存率分彆為80.9％和67.9％,未達到中位OS.16例患者術後複髮,其中跼部複髮5例,遠處轉移11例.1年和2年無瘤生存率分彆為71.9％和44.2％.中位無瘤生存時間(DFS) 20箇月(95％可信區間8.1～31.9箇月).將患者按單站或多站N2轉移分為兩箇亞組進行分層分析,結果顯示,單站N2暘性和多站N2暘性患者的1年、2年總生存率分彆為87.7％、78.9％和67.6％、59.1％.1年、2年無瘤生存率分彆為88.9％、49.4％和55.3％、39.5％.中位DFS分彆為23箇月(95％可信區間8.1～31.9箇月)和16箇月(95％可信區間2.9～ 29.0箇月),單站N2暘性患者的預後好于多站N2暘性患者.結論 對于術前經仔細分期無N2淋巴結轉移的NSCLC患者,隻要技術可行,應積極行全胸腔鏡肺葉切除術,即使術後病理證實存在縱隔N2淋巴結轉移,多數也是微小轉移或者單站轉移,亦可以達到根治手術要求,穫得令人滿意的療效.
목적 탐토술후발현병리N2(ⅢA)기비소세포폐암전흉강경폐협절제술치료적료효.방법 회고성분석35례(10.1％,35/348례)、접수전흉강경폐협절제술、술전림상분기Ⅰ기이술후의외발현병리N2양성적비소세포폐암환자적림상자료,총결기림상특정、술후단기료효、복발모식이급중기예후.결과 전조무위수술기사망.26례직접행폐협절제,9례선행설형절제、후행폐협절제.소유환자완성R0절제,중위수술시간190 min,중위술중출혈량200 ml.술중청소N2참종격림파결중위4참화10개림파결,기중전이양성중위1참화2개림파결,유18례위단참N2림파결전이.술후중위흉강인류8천,중위주원11천.12례출현병발증15례차,균경대증치료후호전.소유환자안규범접수4개료정함박쌍약방안보조화료.환자균수방1 ～55개월,중위치23개월.지수방기말(2011년4월),25례생존,1년화2년총생존솔분별위80.9％화67.9％,미체도중위OS.16례환자술후복발,기중국부복발5례,원처전이11례.1년화2년무류생존솔분별위71.9％화44.2％.중위무류생존시간(DFS) 20개월(95％가신구간8.1～31.9개월).장환자안단참혹다참N2전이분위량개아조진행분층분석,결과현시,단참N2양성화다참N2양성환자적1년、2년총생존솔분별위87.7％、78.9％화67.6％、59.1％.1년、2년무류생존솔분별위88.9％、49.4％화55.3％、39.5％.중위DFS분별위23개월(95％가신구간8.1～31.9개월)화16개월(95％가신구간2.9～ 29.0개월),단참N2양성환자적예후호우다참N2양성환자.결론 대우술전경자세분기무N2림파결전이적NSCLC환자,지요기술가행,응적겁행전흉강경폐협절제술,즉사술후병리증실존재종격N2림파결전이,다수야시미소전이혹자단참전이,역가이체도근치수술요구,획득령인만의적료효.
Objective To assess early and medium outcomes of pathologic N2 disease unexpectedly detected in patients undergoing total video-assisted thoracic surgery lobectomy for non-small cell lung cancer.Methods Between Sep.2006 and Dec.2010,348 patients with Non-small cell lung cancer underwent total video-assisted thoracic surgery lobectomy,and within them,35( 10.1％ ) were found to have pathologic N2 disease after operation.We retrospectively reviewed the clinical and pathologic features of patients with unexpected N2 disease after video-assisted thoracic surgery lobectomy and their early and medium outcomes,including survival and recurrence pattern.Results No perioperative mortality was noted.26 patients received a lobectomy directly,and the other 9 patients after a wedge resection.All the patients had R0 resection.The medium operation time was 190 minutes and medium blood loss was 200ml.The medium stations and numbers of dissected N2 lymph nodes in operation were 4 and 10,respectively.And the medium stations and numbers of metastatic N2 Lymph nodes were 1 and 2,respectively.Among patients with pathologic N2 disease,18 (51.4％) had single-station involvement.The median duration of chest tube placement was 8 days.The median length of hospital stay was 11 days.15 complications occurred in 12 (34.3％) patients.All of the patients underwent adjuvant chemotherapy with platinum postoperatively.The median follow-up time was 23 months.The 1 - and 2-year overall survival (OS) was 80.9％ and 67.9％,and the medium OS was not reached.During follow-up,16 (45.7％) patients had a recurrence.The pattern of recurrence was locoregional in 5,distant in 11.The 1 - and 2-year disease-free survival (DFS) was 71.9％ and 44.2％,and the medium DFS was 20 months (95％,8.1 to 31.9 months).Divided the patients with pathologic N2 disease into two groups considering single-station involvement or not,the 1-and 2-year OS and DFS for the single-station group and for the multiple-station group were 87.7％,78.9％ ; 88.9％,49.4％and 67.6％,59.1％ ; 55.3％,39.5％.The medium DFS for both the two groups was 23 and 16 months respectively.Conclusion For non-small cell lung cancer with N0 disease confirmed by an exactly preoperative staging workups,if it is feasible in technology,a total video-assisted thoracic surgery lobectomy should be recommended.Even if N2 lymph node metastasis is unexpectedly detected postoperatively,the metastasis was mostly micro- or single-station involved,and a similar outcome with conventional thoracotomy can be achieved.
