早期肺癌特异性淋巴清扫的临床回顾研究

背景与目的 本研究旨在探讨不同淋巴结清扫方式对Ⅰ期肺癌患者生存率的影响,考察影响预后的相关因素,探讨肺叶特异性淋巴结清扫的临床应用指征.方法 回顾性分析1998年-2005年上海市胸科医院病理Ⅰ期且符合完全性切除的379例肺癌患者,其中系统性淋巴结清扫组148例,肺叶特异性淋巴结清扫组150例,术后病理均为T1a-2aN0M0,比对研究两组手术相关因素并进行预后分析.结果 两组临床病理特征无统计学差异(P＞0.05);两组总体3年及5年生存率无统计学差异(P＞0.05),但不同病理分期、病理类型和肿瘤直径之间的生存率存在明显差异(P＜0.01);在手术时间、术中失血、胸管引流量、拔管时间及住院天数等方面,两组存在明显差异(P＜0.01);两组术后并发症亦有统计学差异(P＜0.05).结论 系统性淋巴结清扫并未增加Ⅰ期肺癌患者5年生存率;病理分期、病理类型和肿瘤直径是影响患者预后的重要因素;肺叶特异性淋巴结清扫可明显减少手术并发症并降低围手术期风险.

Retrospective Study on Lobe-specific Lymph Node Dissection for Patients with Early-stage Non-small Cell Lung Cancer

Background and objective The aim of this study is to explore the effects of different modes of lymph node dissection in early-stage non-small cell lung cancer (NSCLC) on the survival rate, to study the prognostic factors, and to discuss the clinical application of lobe-specific lymph node dissection. Methods A total of 379 patients with completely resected pathological stage I NSCLC between the years 1998 and 2005 at Shanghai Chest Hospital were retrospectively analyzed. Among the patients, 148 were placed in the systematic lymph node dissection group and 150 in the lobe-specific lymph node dissection group. All of them were in pathological stage I (T1a-2aN0M0). The differences between the two groups were compared. Results No statistical difference was found between the two sets of data in terms of the clinical and pathological features of distribution (P>0.05). The overall survival distribution between the two groups had no statistical difference (P>0.05). The pathological stage, pathological type, and tumor size significantly differed between the two groups. The duration of surgery, blood loss, blood transfusion, drain secretion, duration of drainage, and duration of hospital stay also significantly differed between the two groups (P<0.01). The complications significantly differed between the two groups as well (P<0.05). Conclusion Systematic lymph node dissection does not improve the five-year survival rates in pathological stage I NSCLC. The pathological stage, pathological type, and tumor size critically affect the prognosis. Lobe-specific lymph node dissection can significantly reduce complications and perioperative risks.