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find Keyword "纵隔淋巴结" 10 results
  • 直径≤3 cm的周围型肺腺癌淋巴结转移分析

    摘要: 目的 探讨原发性周围型小肺腺癌(直径≤3cm)淋巴结转移的规律,为治疗方案的制定提供参考。 方法 自1990年1月至2009年1月期间,首都医科大学附属北京友谊医院胸外科手术治疗肿瘤最大径(CT测量)≤3 cm的周围型原发性肺腺癌288例,其中男223例,女65例;年龄30~73岁。288例患者诊断均经病理检查证实,临床诊断淋巴结转移的标准为最小直径大于1.0 cm(CT)。手术方式:肺叶切除术264例,肺袖式切除术22例,肺楔形切除术2例;纵隔淋巴结清扫方式为系统纵隔淋巴结清扫或采样。 结果 288例中发生淋巴结转移142例(49.30%),其中术后分期为N1 90例(31.25%),N2 52例(18.06%)。不同原发部位的淋巴结转移率:右肺46.67%(77/165),左肺56.10%(69/123);肿瘤直径小于1 cm者淋巴结转移率为22.22%(2/9),1~2 cm之间者为39.44%(28/71),2~3 cm之间者为53.84%(112/208),三者间比较差异有统计学意义(Plt;0.01)。直径小于1 cm者未发现N2转移,1~2 cm之间者N2阳性率为14.08%(10/71),2~3 cm之间者N2阳性率为20.19%(42/208),三者间比较差异有统计学意义(χ2=20.01,Plt;0.01)。 结论 周围型小肺腺癌肺门及纵隔淋巴结转移常见,尤其是右肺上叶肺癌。直径大小对腺癌淋巴结转移发生率有明显的影响,但即便直径小于2 cm,淋巴结转移仍有很大的风险。术前应尽可能获得准确的N分期,如不能在术前确定N分期,对直径1 cm以上的肺腺癌术中应常规进行纵隔淋巴结清扫,否则难以获得准确的分期,亦难以达到根治性切除。

    Release date:2016-08-30 06:02 Export PDF Favorites Scan
  • 纵隔镜诊断成人单纯纵隔淋巴结病变

    目的探讨纵隔镜检查在诊断成人单纯纵隔淋巴结病变中的作用。方法对120例纵隔淋巴结肿大患者采用标准颈部纵隔镜检查术或胸骨旁纵隔镜检查术获取可疑组织标本行病理学检查。结果通过纵隔镜检查本组120例患者中有113例获得明确的病理诊断,总确诊率为94.2%(113/120);成人单纯纵隔淋巴结病变以结节病(59.2%)、 淋巴滤泡增生(16.7%)、淋巴结结核(11.7%)最为多见。手术时间64.2±21.5min,失血量45.6±26.8ml;穿破左侧胸膜1例,术后死亡1例,死因为药物性血管内溶血。结论纵隔镜检查术是诊断成人单纯纵隔淋巴结病变的一种高效、安全的检查方法。

    Release date:2016-08-30 06:25 Export PDF Favorites Scan
  • 非小细胞肺癌跳跃性纵隔淋巴结转移及其廓清的临床探讨

    目的 探讨非小细胞肺癌(NSCLC)跳跃性纵隔淋巴结转移(跳跃性N2)的特点及转移方式,为制定合理的纵隔淋巴结廓清范围提供依据. 方法 回顾性总结121例(广州军区总医院1996~1999年101例和北京大学深圳医院1999~2000年20例)经系统性淋巴结廓清后病理证实为N2的NSCLC患者的临床资料,将跳跃性N2与非跳跃性N2的数据进行比较. 结果 发现跳跃性N2 23例(19.0%),其中腺癌18例(78.3%).跳跃性N2患者中平均每例纵隔淋巴结转移组为1.1组,明显低于非跳跃性N2的3.1组.肺上叶肿瘤跳跃性N2多位于第4或第5组淋巴结,肺下叶肿瘤跳跃性N2多位于第7和第8组淋巴结. 结论 跳跃性N2是NSCLC纵隔淋巴结转移的一个独特亚群.在行肺上叶癌根治术时,应常规清扫第4或第5组淋巴结;在行肺下叶癌根治术时,应常规清扫第7和第8组淋巴结.

    Release date:2016-08-30 06:30 Export PDF Favorites Scan
  • Clinical Analysis of Metastasis Discipline in Superior Mediastinum Lymph Node of Thoracic Esophageal Carcinoma

    ObjectiveTo explore the discipline of superior mediastinum lymph node metastasis of esophageal carcinoma, laying a foundation for the standardization of lymphadenectomy. MethodsWe retrospectively analyzed the clinical data of 586 patients with esophageal carcinoma in our hospital between June 2009 and June 2014. There were 489 males and 97 females at age of 61.61±7.92 years. We analyzed the discipline of lymph node metastasis in these patients. ResultsThe mean number of lymph nodes dissection was 20.48±11.01 per patient. A total of 1 212 lymph nodes metastasis was found in 326 patients (55.63%). The ratio of lymph nodes metastasis in the superior mediastinum, lower mediastinum, and abdominal cavity was 29.35%, 25.94%, and 31.74% respectively with no statistical difference among the three groups (χ2=4.839, P=0.089). In regard to upper thoracic esophageal carcinoma, the ratio of lymph nodes metastasis in the superior mediastinum, lower mediastinum, and abdominal cavity was 43.48%, 3.73%, and 13.73% respectively with higher metastasis rate (χ2=32.692, P=0.000) in the upper mediastinum. In middle thoracic esophageal carcinoma patients, there was no statistical differences in the ratio of lymph node metastasis among upper mediastinum (28.19%), lower mediastinum (29.53%), and abdominal cavity (31.54%, χ2=0.566, P=0.753). While in the patients with the lower thoracic esophageal carcinoma, the ratio of lymph nodes metastasis in the superior mediastinum, lower mediastinum, and abdominal cavity was 22.92%, 27.08%, and 41.67%, respectively with higher ratio of lymph nodes metastasis in abdominal cavity (χ2=17.542, P=0.000). The involved ratio of the right recurrent lymph nodes (19.80%) was the highest among all the lymph nodes in the superior mediastinum (χ2=112.304, P=0.000). ConclusionUpper mediastinum is one of the predilection sites of lymph nodes metastasis of esophageal carcinoma, focusing on the resection of superior mediastinum lymph nodes, especially the right recurrent lymph nodes can decrease the chances of relapse by reducing residual tumor cells.

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  • Video-assisted Thoracoscopic Surgery for 27 Adults Patients with Mediastinal Lymph Node Tuberculosis

    ObjectiveTo investigate surgical indications and techniques of video-assisted thoracoscopic surgery (VATS) for mediastinal lymph node tuberculosis. MethodsClinical data of 27 patients who underwent VATS for mediastinal lymph node tuberculosis between January 2010 and March 2013 in Wuhan Medical Treatment Center were retrospectively analyzed. There were 16 male and 11 female patients with their age of 18-67 (30.23±10.72) years. ResultsThere was no in-hospital death. Postoperative complications included recurrent laryngeal nerve injury in 1 patient, delayed wound healing in 1 patient and pneumothorax in 1 patient. Postoperatively, all the patients received intensified anti-tubercular treatment, and were engaged in normal physical activities during follow-up of 6 months. ConclusionVATS is safe and reliable for the treatment of mediastinal lymph node tuberculosis, and anti-tubercular treatment is needed before and after the operation.

    Release date:2016-10-02 04:56 Export PDF Favorites Scan
  • Liquid-Based Cytology Preparation Can Improve Cytological Assessment of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration

    ObjectiveTo investigate whether liquid-based cytology (LBC) can improve diagnostic value of cytological assessment of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). MethodsA cohort of 600 cases who underwent EBUS-TBNA from June 2012 to September 2013 was enrolled in this prospective study in West China Hospital. EBUS-TBNA was carried out under local anesthesia and moderate sedation. The procedure was performed with echobronchoscopes. Histological tissues were stained with hematoxylin and eosin for further study. Additional immunohistological analysis was performed for establishing a reliable diagnosis as necessary. Aspirates were smeared on glass slides and separate aspirates were processed by the monolayer SurePath method. ResultsIn total, 480 cases of malignant tumors and 120 cases of benign lesions were confirmed by histological examination. The sensitivity of SurePath liquid-based preparations and conventional smears was 82.1% and 56.0%, and the specificity was 87.5% and 82.5%, respectively. The combined specificity was 100.0%. The positive predictive value of two methods combined was 96.3% and 92.8%, whereas the negative predictive value was 54.9% and 31.9%, respectively. The difference between the two methods was significant (P < 0.05). ConclusionsLBC preparation can improve cytological assessment of EBUS-TBNA. Histological study is necessary when the cytological diagnosis is obscure.

    Release date:2016-10-10 10:33 Export PDF Favorites Scan
  • Modular dissection of mediastinal lymphadenectomy in uniportal video-assisted thoracoscopic surgery for radical resection of lung cancer

    Objective To investigate the effect of modular disscection of mediastinal lymphadenectomy in uniportal video-assisted thoracoscopic surgery (uniportal-VATS) for lung cancer radical resection and assess its safety and feasibility. Methods Data of 311 patients (171 males and 140 females, a mean age of 59.4±5.1 years) with non-small cell lung cancer (NSCLC) who received modular dissection of mediastinal lymphadenectomy in uniportal-VATS or three portal VATS (3P-VATS group) during March to December 2015 were retrospectively analyzed. There were 208 patients (110 males and 98 females, a mean age of 59.2±5.3 years) in the uniportal-VATS group and 103 patients (61 males and 42 femals, a mean age of 59.7±5.1 years) in the 3P-VATS group. The effects of lymph nodes (LNs) dissection and postoperative clinical data were compared between the two groups, especially for N2 LNs dissection. Results There were no perioperative death in two groups. The overall number of dissected stations and LNs in the uniportal-VATS group (7.3±1.0, 17.5±3.0) were similar with those in the 3P-VATS group (7.2±1.0, 17.7±2.7, P=0.208, P=0.596). The dissected stations (uniportal-VATS: 4.3±0.7, 3P-VATS: 4.3±0.6) and number (uniportal-VATS: 8.6±1.1, 3P-VATS: 8.5±1.1) of N2 LNs were both similar between the two groups (P=0.850, P=0.587). The chest tube duration and postoperative hospital stay of uniportal-VATS group (4.4±1.3 d and 9.2±0.9 d) were much shorter than those of 3P-VATS group (5.0±1.3 d and 9.8±2.0 d, both P<0.001). No significant difference was found in morbidity rate between the two groups (P>0.05). Conclusion Modular dissection of mediastinal lymphadenectomy could meet the requirment of radical resection and it is a safe and valid method which could be used during uniportal-VATS for radical resection of lung cancer.

    Release date:2017-07-03 03:58 Export PDF Favorites Scan
  • Efficacy and safety of different methods of lymphadenectomy for early stage non-small-cell lung cancer: a meta-analysis

    Objectives To systematically review the efficacy and safety of non-systemic lymph dissection (NSMLD) vs. systemic lymph dissection (SMLD) for early stage non-small cell lung cancer (NSCLC). Methods PubMed, EMbase, Web of Science and The Cochrane Library databases were searched online to collect randomized controlled trials (RCTs) and non-randomized controlled studies (NRCTs) of NSMLD vs. SMLD for NSCLC patients from inception to October, 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 software. Results A total of 16 studies (4 RCTs and 12 NRCTs) involving 4 718 patients were included. The results of meta-analysis showed that: Compared with the SMLD group, the NSMLD group had higher mortality (HR=1.23, 95%CI 1.11 to 1.37, P<0.000 1). There were no significant differences in disease-free survival, local recurrence rate, distant metastasis rate, and safety between two groups. In addition, the NSMLD group had shorter operation time, and lower drainage and blood loss. Subgroup analysis was performed according to operation methods. The results showed that: NSMLD group by lymph node sampling (LN-S) had higher mortality than SMLD group (HR=1.43, 95%CI 1.17 to 1.75,P=0.004), NSMLD group by lobe-specific lymph node dissection (L-SLD) did not have higher mortality. Conclusions Current evidence shows that: compared with SMLD, NSMLD by L-SLD do not have higher mortality in early stage NSCLC patients, while NSMLD by LN-S have higher mortality. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusion.

    Release date:2018-01-20 10:09 Export PDF Favorites Scan
  • Pattern of lymph node dissection in non-small cell lung cancer: A systematic review and meta-analysis

    Objective To compare lymph node sampling (LN-S) and lobe-specific lymph node dissection (L-SLD) in the clinical efficacy and safety for early-stage non-small cell lung cancer (NSCLC). Methods PubMed, Medline, EMbase, Web of Science and The Cochrane Library databases were searched up to March 2017 for English language studies. We collected randomized controlled trials (RCTs) and cohort studies (CS) which used the systematic mediastinal lymph node dissection (SMLD) and LN-S or L-SLD for the treatment of NSCLC. Direct meta-analysis was performed using RevMan 5.3 software and indirect meta-analysis with ITC software after two researchers screened the literature, extracted the data and evaluated the risk of bias independently. Results A total of 18 articles were included (4 RCTs and 14 CS, and 10 714 patients). Meta-analysis results showed that in the CS, compared with the the SMLD group, overall survival increased in the L-SLD group (HR=0.99, 95%CI 0.78 to 1.25, P=0.92), and overall survival decreased in the LN-S group with significant difference in CS (HR=1.43, 95%CI 1.17 to 1.75, P=0.000 4), but was not statistically significant in RCT (P=0.35). In terms of disease-free survival, there was no significant difference between the SMLD group and the LN-S group (HR=1.25, 95%CI 0.90, 1.62, P=0.10) as well as the L-SLD group (HR=1.15, 95%CI 0.92 to 1.43, P=0.23) in the CS. There was no significant difference in the local recurrence rate or distant metastasis rate between the non-systematic lymph node dissection (NSMLD) and SMLD in CS and RCTs (CS: P=0.43, P=0.39; RCT: P=0.43, P=0.10). There was no significant difference in the postoperative complications between NSMLD and SMLD in the CS (OR=0.79, 95%CI0.58 to 1.09, P=0.15) and RCTs (OR=0.36, 95%CI 0.09 to 1.45, P=0.15). Indirect meta-analysis showed that risk of death decreased by 31% and risk of recurrence by 35% in the L-SLD group compared with the LN-S group (HR=0.69, 95% CI 0.51 to 0.95, P=0.46; HR=0.65, 95% CI 0.65 to 1.30, P=0.72), but the difference was not statistically significant. Conclusion For early-stage NSCLC, L-SLD is not statistically different from SMLD in terms of survival; however, the overall survival of LN-S is lower than that of systematic lymphadenectomy. Indirect meta-analysis shows that L-SLD reduces the risk of death and recurrence risk compared with LN-S. There is no evidence to support both direct comparison of the prognosis of LN-S and L-SLD, therefore further prospective studies are still needed to verify.

    Release date:2018-07-27 02:40 Export PDF Favorites Scan
  • Wide exposure in uniportal video-assisted thoracoscopic surgery for radical resection of lung cancer

    Objective To investigate the advantage of the concept of wide exposure in uniportal video-assisted thoracoscopic surgery (uniportal-VATS) for radical resection of lung cancer and assess its safety and feasibility. Methods Clinical data of 255 patients (110 males and 145 females, a mean age of 54.3±7.9 years) with non-small cell lung cancer (NSCLC) who received wide exposure in uniportal-VATS or three portal VATS (3P-VATS) during August 2017 to March 2018 were retrospectively analyzed. There were 153 patients (67 males and 86 females, a mean age of 56.1±8.5 years) in the uniportal-VATS group and 102 patients (43 males and 59 femals, a mean age of 54.4±7.4 years) in the 3P-VATS group. The clinical effects were compared between the two groups. Results There was no statistical difference in the operation time between the uniportal-VATS and 3P-VATS (135.0±45.6 min vs. 142.0±39.5 min, P>0.05). The overall number of dissected stations (6.9±1.0) and LNs (14.5±3.0) in the uniportal-VATS group were similar with those in the 3P-VATS group (7.1±1.0, 15.1±1.7). The dissected stations of N2 LNs (uniportal-VATS: 4.1±1.7, 3P-VATS: 3.9±0.8) and number of dissected N2 LNs (uniportal-VATS: 8.0±0.9, 3P-VATS: 7.8±1.1) were both similar between the two groups. The duration of postoperative tube drainage and postoperative hospital stay of uniportal-VATS group (3.5±1.8 d and 7.2±0.9 d) were much shorter than those of 3P-VATS group (4.0±1.3 d and 8.8±2.0 d). No significant difference was found in incidence of postoperative complication between the two groups except that the incidence of subcutaneous emphysema in the uniportal-VATS group was much lower. There was no perioperative death in the two groups. Conclusion The concept of wide exposure in uniportal-VATS can meet the requirment of radical resection and it is a safe and valid method which can be used for radical resection of lung cancer.

    Release date:2019-03-29 01:35 Export PDF Favorites Scan
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