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目的探讨TNM分期(UICC 2011)中T_1期(肿物直径d≤3 cm)的原发性周围型非小细胞肺癌(NSCLC)的淋巴结转移规律,并尽可能找出对患者收益最大化的淋巴结清扫方式。方法回顾性分析2014年11月至2015年5月大连市中心医院胸外科60例原发性周围型NSCLC的临床资料,其中男26例、女34例,年龄34~76(57.91±7.75)岁。记录淋巴结清扫数目及转移情况。结果全组共清扫淋巴结1 208枚,平均每例清扫20.1枚,其中转移淋巴结33枚,转移率为2.73%。常规病理检测未发现纵隔及肺门淋巴结转移51患者。检出单纯第12和(或)13和(或)14组淋巴结转移者共3例,检出率为5.89%。对于T1期原发性周围型NSCLC,随着肿瘤直径增加,淋巴结转移率逐渐升高。实性病灶较非实性病灶[纯磨玻璃结节(p GGO)或混合磨玻璃结节(m GGO)]更易发生淋巴结转移,而非实性病灶一般不会发生淋巴结转移。结论 T_1期原发性周围型NSCLC的淋巴结转移率与肿物直径、性质、病理类型、影像学局部胸膜牵拉有关系,肺内第(12+13+14)组淋巴结清扫能发现可能存在的单纯肺内淋巴结转移,对T_1期原发性NSCLC的分期的划定和治疗方案的选择有重要意义。
Objective To investigate the rule of lymph node metastasis in primary T_1 non-small cell lung cancer (NSCLC) with stage T_1 (tumor size d≤3 cm) in TNM staging (UICC 2011), and to find the lymph nodes Cleaning method. Methods The clinical data of 60 patients with primary peripheral NSCLC admitted to Dalian Central Hospital from November 2014 to May 2015 were retrospectively reviewed. There were 26 males and 34 females with a mean age range of 34 to 76 (57.91 ± 7.75) years . Record the number of lymph node dissection and metastasis. Results A total of 1 208 pieces of lymph nodes were dissected in all groups, with an average of 20.1 pieces per case, of which 33 were metastatic lymph nodes with a metastatic rate of 2.73%. Routine pathological examination found no mediastinal and hilar lymph node metastasis 51 patients. A total of 3 cases of simple 12th and / or 13 and / or 14 lymph node metastases were detected, the detection rate was 5.89%. For T1 primary NSCLC, with the increase of tumor diameter, lymph node metastasis rate gradually increased. Solid lesions are more likely to have lymph node metastases than non-solid lesions [pGGO or mGGO], whereas non-solid lesions generally do not have lymph node metastases. Conclusions The lymph node metastasis rate in primary T_1 stage NSCLC is related to tumor diameter, nature, pathological type and local pleural traction. Pulmonary lymph node dissection in (12 + 13 + 14) Simple pulmonary lymph node metastasis, T 1 primary NSCLC staging delineation and treatment options of great significance.