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目的探讨肺癌手术中纵隔淋巴结廓清程度对术后并发症及引流量的影响,为肺癌术式选择及术后管理提供临床依据。方法将1989～1998年在我院因肺癌行肺叶切除的349例患者(N=349例),按纵隔淋巴结廓清程度分为无纵隔淋巴结廓清组(n_1=74),选择性纵隔淋巴结廓清组(n_1=200及系统纵隔淋巴结廓清组(n_3=75)。对各组病例的术后三天引流量及术后早期并发症出现的频率进行调查分析,并用统计学方法进行处理。结果全组349例患者平均年龄57.7岁,最大为81岁,最小为29岁,男239例,女110例。病理分类:腺癌174例(49.86%),鳞癌128例(36.68%),小细胞肺癌12例(3.44%),大细胞肺癌10例(2.87%),类癌8例(2.29%),其它类型癌或肉瘤17例(4.87%)。在无纵隔淋巴结廓清组(第一组),平均术后三天引流量为639.39ml,选择性纵隔淋巴结廓清组(第二组)为707.15ml。系统纵隔淋巴结廓清组(第三组)为686.73ml。经t检验各组间均无显著性差异(P>0.05)。第一组74例患者中有13例出现并发症(17.57%),第二组200例患者中有32例出现术后并发症(16.00%),而第三组75例患者中有30例出现术后并发症(40.00%)。X~2检验,第一、三组间及第二、三组间并发症的发生率有显著性差异(P<0.01),而第一、二组间并发症的发生率无显著性差异(P>0.05)。结论肺癌手术中纵隔淋巴结廓清程度与术后引流量无关。而系统纵隔淋巴结廓清组术后并发症的发生率要显著高于无廓清组或选择性廓清组。因此提示我们在肺癌手术中确定是否进行系统纵隔淋巴结廓清时要考虑到术后并发症的因素,并有针对性地加强术后管理。
Objective To investigate the effect of mediastinal lymphadenectomy on postoperative complications and drainage in patients with lung cancer and to provide a basis for surgical selection and management of lung cancer. Methods 349 patients (n = 349) with lobectomy due to lung cancer in our hospital from 1989 to 1998 were divided into mediastinal lymph node dissection group (n_1 = 74), mediastinal lymph node clearance group (n = n_1 = 200 and the system of mediastinal lymphadenectasis group (n_3 = 75) .Three days after operation in each group, the drainage and the frequency of early postoperative complications were analyzed and statistically analyzed.Results All patients in group 349 The average age of patients was 57.7 years old, the maximum was 81 years old, the minimum was 29 years old, there were 239 males and 110 females.Pathological classification: adenocarcinoma in 174 cases (49.86%), squamous cell carcinoma in 128 cases (36.68%), small cell lung cancer (3.44%), large cell lung cancer in 10 cases (2.87%), carcinoid tumor in 8 cases (2.29%) and other types of cancer or sarcoma in 17 cases (4.87%) .In the mediastinal lymph node clearance group Three days after operation, the drainage volume was 639.39ml, selective mediastinal lymph node clearance group (the second group) was 707.15ml, and the mediastinal lymph node clearance group (the third group) was 686.73ml.There was no significant difference between the groups by t test (P> 0.05). Complications were found in 13 of the 74 patients in the first group (17.57%) and 32 of the 200 patients in the second group (16.00%), Thirty patients in the third group had postoperative complications (40.00%) in 30 patients.The incidence of complications in the first and third groups and in the second and third groups was significantly different between the two groups (P < 0.01), while there was no significant difference in the incidence of complications between the first and second groups (P> 0.05) .Conclusion The degree of mediastinal lymph node dissection in lung cancer surgery has nothing to do with the postoperative drainage volume, while the postoperative complications of the mediastinal lymph node dissection group Of the incidence was significantly higher than non-clearance group or selective clearance group.Therefore, we are prompted to determine in lung cancer surgery whether to carry out the system of mediastinal lymph node clearance should take into account the factors of postoperative complications, and targeted to strengthen postoperative management .