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目的 探讨非小细胞肺癌 (NSCLC)外科治疗中系统性淋巴结清扫的作用。 方法 对可手术的 5 0 4例Ⅰ～ⅢA期病例随机分成研究组和对照组。研究组在肺切除同时行系统纵隔淋巴结清扫术 ;对照组则在肺切除同时仅行肺门淋巴结清扫术 ;纵隔淋巴结肉眼怀疑转移者则行该淋巴结摘除术。凡符合入选标准病例均对术式、病理类型、病理分级、肿瘤体积、淋巴结切除总数目、淋巴结转移数目、淋巴结转移比 (淋巴结转移数量 /淋巴结切除总数量 )、PTNM分期、辅助治疗、随访期间内的复发转移、手术并发症、生存时间、生存质量等 13项指标进行观察和评价。生存分析用Kaplan Meier法 ,预后分析用Cox成比例危险率模型。 结果 5 0 4例中 ,符合研究标准的病例共 32 0例 ,研究组16 0例 ,平均每例切除淋巴结 9 49个 ;对照组 16 0例 ,平均每例切除淋巴结 3 6 3个。Ⅰ期肺癌研究组的 1,3,5 ,9年生存率分别为 91 8%、86 9%、81 4%和 74 2 % ,对照组为 88 7%、72 5 %、5 8 5 %和5 2 1% ,差异有显著性。Ⅱ、ⅢA期两组间的生存曲线差异无显著性。影响长期生存率的因素有术后分期、淋巴结转移比和淋巴结清扫范围 3个因素。 结论 肺叶 (全肺 )切除加上系统性的胸内淋巴结清扫 ,能减少肺癌术后局部复发率和远处转移率 ,提高长期生
Objective To investigate the role of systemic lymph node dissection in surgical treatment of non-small cell lung cancer (NSCLC). Methods A total of 504 operable I-IIIA cases were randomly divided into study group and control group. The study group underwent systemic mediastinal lymph node dissection at the time of pulmonary resection. In the control group, hilar lymph node dissection was performed only at the time of lung resection. Those with mediastinal lymph nodes who were suspected of metastasis with the medial lymph node dissection. All cases that met the inclusion criteria were surgical, pathological, pathological grade, tumor volume, total number of lymph node resection, number of lymph node metastases, lymph node metastasis ratio (number of lymph node metastasis/total lymph node resection), PTNM stage, adjuvant treatment, follow-up period The 13 indicators including recurrence, surgical complications, survival time, and quality of life were observed and evaluated. Kaplan Meier method for survival analysis and Cox proportional hazards model for prognosis analysis. Results Of the 504 cases, 32 cases met the study criteria, 160 cases in the study group, with an average of 9,49 lymph nodes removed per case, and 160 cases in the control group, with an average of 363 lymph nodes removed per case. The 1-, 5-, and 9-year survival rates of the Phase I lung cancer study group were 91 8%, 86 9%, 81 4%, and 74 2%, respectively, and the control group was 88 7%, 72 5%, and 585%. 5 2 1%, the difference is significant. There was no significant difference in survival curves between groups II and IIIA. Factors that affect long-term survival include postoperative staging, lymph node metastasis, and lymph node dissection. Conclusion Pulmonary lobe (full lung) resection combined with systemic intrathoracic lymph node dissection can reduce postoperative local recurrence rate and distant metastasis rate of lung cancer and improve long-term survival.