肺癌患者肺门纵隔淋巴结的合理清扫方式与范围探讨

目的：探讨肺癌患者肺门纵隔淋巴结的合理清扫方式与范围。方法：选择2006年1月－2008年1月于本院手术治疗的肺癌患者45例，回顾性分析了其病例资料，分析术前胸部CT和MRI对肺门纵隔淋巴结转移的判断与术后病理结果的一致性．同时比较系统采样病例胸内各区淋巴结的转移频度，以及肺门纵隔淋巴结系统采样与单纯采样术的阳性发现率。结果：患者术前CT诊断和术后病理对肺门纵隔淋巴结转移的结果的一致性进行检验，κ为0．351；MRI诊断一致性检验．κ为0．449，优于CT。距离肺门和肺根部最近的11、10、7、5、4区淋巴结的转移频度最高，距离肺根部较远的9、6、3、2、1区淋巴结的转移频率较低。肺门纵隔淋巴结系统采样40例，阳性发现率为85．0％；单纯采样10例，阳性发现率为60．0％，两组间比较差异有统计学意义（χ^2=13．28，P〈0．05）。结论：胸部CT和MRI不应作为术前肺癌N分期的唯一检查，应引入进一步的其他诊断技术，以提高对肺门纵隔淋巴结分期的准确性。在肺癌术中应主动清除肺门和纵隔各区淋巴结，特别是围绕肺门或肺根部周围的淋巴结，不能忽略淋巴结转移的现象。系统淋巴结采样术较适合肺癌的根治性手术治疗。

The reasonable manner and scope of hilar and mediastinal lymph node in Datients with lung cancer

Objective： To explore the reasonable manner and scope of hilar and mediastinal lymph node in patients with lung cancer. Methods： 45 patients with lung cancer were selected as research subject, who had been treated with surgery from Jan.2006 to Jan.2008 in our hospital.We made a retrospective analysis of its clinical data, analysis preoperative chest CT and MRI of the right hilar and mediastinal lymph node metastasis and postoperative pathology results to determine consistency, while a more systematic sampling of cases of intrathoracic lymph node metastasis frequency in various districts, as well as systematic sampling of hilar and mediastinal lymph node sampling technique purely positive detection rate. Re- suits： The preoperative CT diagnosis and pathological mediastinal lymph node metastasis to the hilar consistency of the results of the inspection, κ was 0.351; MRI diagnosis of consistency tests, κ was 0.449.The consistency of MRI was better than CT,the highest frequency of lymph node metastasis were from the recent 11,10,7,5,4 area around Hilar and pulmonary roots,9,6,3,2,1 area farther away from the root zone pulmonary lymph node metastas was less frequently.Hilar and mediasti hal lymph node systematic sampling of 40 cases, the positive detection rate was 85.0%;pure sample of 10 cases, the positive rate of 60.0%. It was found the positive detection rate between the two groups was significant difference （χ^2=13.28, P〈0.05）. Conclusion： The chest CT and MRI should not be the only checks in judging preoperative N staging of lung cancer, further other diagnostic techniques should be introduced to improve the accuracy of staging of hilar and mediastinal lymph nodes. In lung cancer surgery should take the initiative to clear the district of hilar and mediastinal lymph nodes, particularly around the roots of the surrounding hilar or pulmonary lymph nodes.Systematic lymph node sampling for lung cancer compared with radical surgery.