【摘要】：背景與目的非小細胞肺癌(NSCLC)切除術(shù)中規(guī)范化淋巴結(jié)清掃具有重要意義。根據(jù)UICC及AJCC的推薦,NSCLC淋巴結(jié)可分為第一站(N1)及第二站(N2),其中第一站淋巴結(jié)包括肺門(No10)、葉間(No11)、葉支氣管旁(No12)、段支氣管旁(No13)及亞段支氣管旁(No14)。而第13及第14組淋巴結(jié)又被稱為肺內(nèi)淋巴結(jié)(Intrapulmonary lymph node,ILN)。在臨床實際工作中通常對ILN的清掃及送檢未予以足夠重視,本研究旨在研究NSCLC切除術(shù)中規(guī)范化肺內(nèi)淋巴結(jié)清掃的臨床價值。方法收集2013年1月至2015年12月間在重慶醫(yī)科大學附屬第一醫(yī)院胸外科同一手術(shù)組連續(xù)接受根治性手術(shù)切除的234例原發(fā)性周圍型NSCLC患者,當病肺切除以后,術(shù)者以組織剪沿支氣管樹進行解剖,對相關(guān)區(qū)域淋巴結(jié)(即No12、No13、No14)逐一剪下、分袋儲存并標記送病理學檢查。手術(shù)中對縱隔淋巴結(jié)同時行系統(tǒng)性清掃。結(jié)果共清掃N1淋巴結(jié)3019枚,平均每例12.90枚,其中轉(zhuǎn)移263枚,轉(zhuǎn)移率為8.71%。跳躍性N2轉(zhuǎn)移患者11例(4.70%)。常規(guī)病理檢測無N2及N1淋巴結(jié)轉(zhuǎn)移者共135例(57.69%)。檢出第13或/和第14組淋巴結(jié)轉(zhuǎn)移的患者16例,占6.84%。N1淋巴結(jié)陽性患者中,No10、No11、No12、No13、No14淋巴結(jié)轉(zhuǎn)移陽性率分別為2.69%,10.51%,9.83%,10.43%,8.48%。若不清掃No13及No14,N1轉(zhuǎn)移漏診率達6.84%(16/234)。結(jié)論術(shù)中肺內(nèi)淋巴結(jié)的規(guī)范清掃有助于發(fā)現(xiàn)可能漏診淋巴結(jié)轉(zhuǎn)移,這將對原發(fā)性NSCLC的準確分期和術(shù)后輔助治療方案的選擇有重要意義。
[Abstract]:Background and objective standardized lymph node dissection in (NSCLC) resection of non-small cell lung cancer is of great significance. According to the recommendation of UICC and AJCC, NSCLC lymph nodes can be divided into the first station (N1) and the second station (N2). The first stage lymph nodes include hilar (No10), interlobar (No11), paratobronchial (No12), segmental bronchus (No13) and subsegmental bronchus (No14). The 13th and 14th groups of lymph nodes are also known as intrapulmonary lymph nodes (Intrapulmonary lymph node,ILN). In clinical practice, insufficient attention has been paid to the cleaning and examination of ILN. The purpose of this study was to study the clinical value of standardized intrapulmonary lymph node dissection in NSCLC resection. Methods from January 2013 to December 2015, 234 patients with primary peripheral NSCLC underwent radical resection in the same operation group, the first affiliated Hospital of Chongqing Medical University. After pneumonectomy, the patients were dissected along the bronchial tree, the lymph nodes (i.e. No12,No13,No14) in the related areas were cut off one by one, stored in bags and marked for pathological examination. The mediastinal lymph nodes were systematically cleaned at the same time during the operation. Results A total of 3019 N1 lymph nodes were removed, with an average of 12.90 lymph nodes per case, of which 263 were metastases, the metastasis rate was 8.71%. There were 11 patients (4.70%) with jump N2 metastasis. 135 cases (57.69%) had no N _ 2 and N _ 1 lymph node metastasis by routine pathology. Among the 16 patients with lymph node metastasis in group 13 or / and group 14, the positive rates of No10,No11,No12,No13,No14 lymph node metastasis were 2.69%, 10.51%, 9.83%, 10.43% and 8.48%, respectively. The missed diagnosis rate of No13 and No14,N1 without cleaning was 6.84% (16 / 234). Conclusion the standard cleaning of intraoperative pulmonary lymph nodes is helpful to detect the possible missed diagnosis of lymph node metastasis, which will be of great significance for the accurate staging of primary NSCLC and the choice of postoperative adjuvant treatment.
【學位授予單位】：重慶醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R734.2

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