原发性肺癌胸部CT表现与手术切除的关系探讨

目的探讨原发性肺癌胸部ＣＴ表现与手术切除的关系。方法将９５例经手术和病理证实为原发性肺癌的患者分为３组：根治性切除组、姑息性切除组、探查组。分别测量３组ＣＴ肿瘤直径、纵隔肺门淋巴结受侵ＣＴ纵向厚度,记录纵隔、肺门及胸内结构改变。结果根治性切除组、姑息性切除组、探查组肿瘤直径分别为４．１０±１．７５,３．９０±１．２０,５．２０±３．６６（ｃｍ,ｘ±ｓ,Ｐ＞０．０５）。纵隔肺门淋巴结受侵ＣＴ扫描纵向厚度分别为２．６８±１．６０,４．０２±１．５６,４．８５±３．２８（Ｐ＜０．０１,Ｐ＜０．０５）。手术探查组ＣＴ特征主要表现为纵隔、肺门结构变形。结论肿瘤直径大小与手术切除无明显直接关系,纵隔肺门淋巴结受侵厚度是影响手术切除的重要因素。当纵隔肺门淋巴结受侵、胸部ＣＴ纵向厚度≤２．６８±１．６０ｃｍ时,临床上可行根治性肺切除。明显纵隔、肺门结构变形可视为手术禁忌症。

Chest CT and its assessment of resectability in lung cancer

OBJECTIVE: To evaluate chest CT and its relation to possible surgical resection in lung cancer patients. METHODS: Ninty-five patients who were diagnosed and confirmed as having lung cancers by surgery and pathology were divided into three groups: (1) Radical resection group; (2) Palliative resection group and (3) Thoractomy group. The diameter of the tumor, the proximity to mediastinum and/or the hilum and the invasion of their lymph nodes were measured. Meanwhile, the changes in the mediastinum and thoracic cavity on the chest CT were noted in these three groups. RESULTS: The diameter of the tumor in each group was 4.10 +/- 1.75, 3.90 +/- 1.20, 5.20 +/- 3.66 (cm, mean +/- s, P > 0.05). The proximity to the mediastinum and/or the hilum and the invasion of their lymph nodes was 2.68 +/- 1.60, 4.02 +/- 1.56, 4.85 +/- 3.28 (cm, mean +/- s, P < 0.01, P < 0.05). The characteristic change in the thoractomy group is deformity in the lymph nodes in the mediastinum and hilum. CONCLUSION: There is no obvious relation between the diameter of the lumg tumor and surgical resection, but the proximity to the mediastinum and/or the hilum and the invasion of their lymph nodes is an important factor. It is possible to perform a radical resection when its contact is less than 2.68 +/- 1.60 cm. Obvious deformity of the mediastinal structures and the hilum is a contraindication for lung cancer surgery.