CAJ | 학술논문

目的探讨应用电视纵隔镜对可切除非小细胞癌患者行术前系统性纵隔淋巴结切除的可行性.方法对56例术前检查发现有影像学纵隔淋巴结肿大的非小细胞肺癌患者,电视纵隔镜下行系统性纵隔淋巴结切除,同时记录手术时间、出血量、并发症、每例切除各组纵隔淋巴结数目.其中纵隔淋巴结阴性和单站转移的患者在术后2周行根治性肺癌手术,对2站及以上转移的患者行术前新辅助化疗2周期后行根治性手术.手术中对已行纵隔镜系统性淋巴结切除的区域再次探查,了解有无淋巴结残留.结果全组56例患者经电视纵隔镜行术前系统性纵隔淋巴结切除,耗时26 ～ 86 min,平均(42 ±13.5) min；术中平均出血少于40 ml,全组无并发症,无死亡,平均住院3天.共切除淋巴结682枚,每例5 ～ 24枚,平均(12.4±6.7)枚；发现转移淋巴结170枚.第2、4、5、7和8各组淋巴结切除率分别为54.5％、92.7％、58.2％、100％和61.8％.术后诊断分期为No者13例,N2者42例,N3者1例.纵隔淋巴结阴性13例和单站转移26例的患者在术后2周接受根治性肺癌手术,2站(包括2站)以上纵隔淋巴结转移的16例患者,先进行2周期的术前新辅助化疗,再进行根治性手术.经术中对纵隔镜淋巴结切除区域再次探查发现有5例共16枚淋巴结残留,分别分布于第2、4、7组,所有残留淋巴结切除送病理检查,结果均为阴性.因此,纵隔镜系统淋巴结切除的N2淋巴结诊断率可达100％,90.9％(50/55),患者达到完全切除.结论应用电视纵隔镜对非小细胞肺癌行术前系统性纵隔淋巴结切除安全可行,可进一步提高纵隔淋巴结诊断准确性,更加有助于针对不同患者选择个体化的治疗方案,在新辅助治疗和微创治疗中有重要作用,可深入研究以便于进一步规范肺癌个体化多学科综合治疗策略.
목적 탐토응용전시종격경대가절제비소세포암환자행술전계통성종격림파결절제적가행성.방법 대56례술전검사발현유영상학종격림파결종대적비소세포폐암환자,전시종격경하행계통성종격림파결절제,동시기록수술시간、출혈량、병발증、매례절제각조종격림파결수목.기중종격림파결음성화단참전이적환자재술후2주행근치성폐암수술,대2참급이상전이적환자행술전신보조화료2주기후행근치성수술.수술중대이행종격경계통성림파결절제적구역재차탐사,료해유무림파결잔류.결과 전조56례환자경전시종격경행술전계통성종격림파결절제,모시26 ～ 86 min,평균(42 ±13.5) min；술중평균출혈소우40 ml,전조무병발증,무사망,평균주원3천.공절제림파결682매,매례5 ～ 24매,평균(12.4±6.7)매；발현전이림파결170매.제2、4、5、7화8각조림파결절제솔분별위54.5％、92.7％、58.2％、100％화61.8％.술후진단분기위No자13례,N2자42례,N3자1례.종격림파결음성13례화단참전이26례적환자재술후2주접수근치성폐암수술,2참(포괄2참)이상종격림파결전이적16례환자,선진행2주기적술전신보조화료,재진행근치성수술.경술중대종격경림파결절제구역재차탐사발현유5례공16매림파결잔류,분별분포우제2、4、7조,소유잔류림파결절제송병리검사,결과균위음성.인차,종격경계통림파결절제적N2림파결진단솔가체100％,90.9％(50/55),환자체도완전절제.결론 응용전시종격경대비소세포폐암행술전계통성종격림파결절제안전가행,가진일보제고종격림파결진단준학성,경가유조우침대불동환자선택개체화적치료방안,재신보조치료화미창치료중유중요작용,가심입연구이편우진일보규범폐암개체화다학과종합치료책략.
Objective This study was performed to assess the clinical feasibility of video-assisted mediastinoscopic lymphadenectomy in the treatment of resectable lung cancer.Methods Between March 2011 and May 2012,we retrospectively analyzed the data from 56 patients who underwent video-assisted mediastinoscopic lymphadenectomy(VAMLA).In patients receiving tumour resection subsequently,radicality of the previous mediastinoscopic dissection was controlled during thoracotomy.Results Mean operative time of video-assisted mediastinoscopic lymphadenectomy was(42.0 ± 13.5) min(range of 26-86 min).Mean number of resected lymph nodes was 12.4 ± 6.7 (range of 5-24).In video-assisted mediastinoscopic lymphadenectomy,the rates of lymph node dissection of stations 2,4,5,7,8 were 54.5％,92.7％,58.2％,100％,61.8％,respectively,there was no operative mortality and morbility.90.9％ patients achieved radical dissection.Conclusion Video-assisted mediastinoscopic lymphadenectomy is a clinically feasible procedure and provides more accurate staging of mediastinal node in lung cancer patients.It also plays an important role in minimal invasive surgery and neoadjuvant therapy.