经颈纵隔镜行对侧纵隔淋巴结切除术在非小细胞肺癌治疗中的临床应用探索

经颈纵隔镜行对侧纵隔淋巴结切除术在非小细胞肺癌治疗中

的临床应用探索

【摘要】目的提出经颈纵隔镜淋巴结清扫术（transcervical video-assisted mediastinoscopic lymphadenectomy，VAMLA）行对侧纵隔淋巴结切除这一手术方法在非小细胞肺癌（NSCLC）手术中的应用，并探讨其在NSCLC中的应用指征及价值。方法在2015年1月至2016年3月共实施了25例VAMLA联合非小细胞肺癌根治手术，其对相关临床资料及术后病理结果资料进行分析。结果所有病例均顺利完成手术，无手术死亡病例。2例出现CT下对侧纵隔淋巴

结阴性但纵隔镜切除后检查发生纵隔淋巴结转移，2例均为腺癌。23例对侧纵隔淋巴结均为病理阴性，进一步行肺癌根治手术。其中PET-CT考虑对侧纵隔淋巴结转移，但纵隔镜切除后实际纵膈淋巴结无转移3例。鳞癌15例，腺癌8例，左侧肺癌19例，右侧肺癌4例。结论VAMLA行对侧纵隔淋巴结切除术在非小细胞肺癌的应用，不仅仅使肺癌的分期更加准确，全面，对于下一步的治疗决策的制定、预后评估具有重要意义；也有利于术后的复查及评估。

【关键词】非小细胞肺癌；经颈纵隔镜淋巴结清扫术；VAMLA；纵隔镜；纵隔淋巴结Clinical Application of Contralateral Mediastinal Lymph Node Dissection

through Mediastinoscopy on Non-small Cell Lung Cancer

LI Xu，WANG Wen-xiang，YANG De-song，TANG Jin-ming，ZHANG Bai-hua，WU Jie，

Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine，the Second Department of Thoracic Surgery，Central South University，Changsha，Hunan，China，410013

Corresponding author：LI Xu，Email：lixu@

[Abstract] Objective The method of transcervical video-assisted mediastinoscopic lymphadenectomy（VAMLA）practises contralateral mediastinal lymph node dissectionin on non-small cell lung cancer（NSCLC）and to discuss its indications and value. Methods Twenty - five patients had been undergone VAMLA combined with non - small cell lung cancer underwent radical surgery from January 2015 to March 2016. The clinical data and pathological results were analyzed. Results All the cases were successfully completed without operative death. 2 cases of CT considered contralateral mediastinal lymph node metastasis，but the actual mediastinal lymph node through mediastinoscopic lymphadenectomy is negative in 2 cases，both of adenocarcinoma.

23 cases of contralateral mediastinal lymph nodes were pathologically negative，further radical surgery for lung cancer. PET-CT considered contralateral mediastinal lymph node metastasis，but the actual mediastinal lymph node through mediastinoscopic lymphadenectomy is negative in 3 cases. Squamous cell carcinoma in 15 cases，8 cases of adenocarcinoma，19 cases of left lung cancer，right lung cancer in 4 cases. Conclusions VAMLA，not only to make lung cancer staging more accurate，comprehensive，for the next step in the development of treatment decisions，prognosis is also significant；and because of the mediastinal lymph node dissection is complete，is conducive to postoperative review and assessment.

[Key words] non-small cell lung cancer，transcervical video-assisted mediastinoscopic lymphadenectomy，Mediastinalscopy，mediastinal lymph node

纵隔淋巴结转移情况对于非小细胞肺癌（NSCLC）的分期、治疗决策、预后评估具有极其重

要的意义。区域淋巴结转移是NSCLC的重要预后因素及预测因子。手术后区域淋巴结复发是NSCLC治疗失败的主要原因之一。