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目的:探讨和筛选出对非小细胞肺癌(NSCLC)N3组淋巴结需行纵隔镜探查活检的临床指征。方法:89例Ⅰ～ⅢA期NSCLC患者开胸术前行经颈纵隔镜检查,其中12例联合右斜角肌活检术、10例联合前纵隔切开术检查N3组淋巴结的病理状况。结果:纵隔镜检查后共发现9例为不宜再行开胸手术患者,其中3例为右斜角肌淋巴结转移,6例为病灶对侧纵隔淋巴结转移。统计学分析显示,肺腺癌组的N3发生率高于非腺癌组(P<0.05),血清CEA水平升高组的N3发生率高于正常组(P<0.05),同侧纵隔淋巴结多站转移组的N3发生率高于同侧单站转移组(P<0.05)。结论:肺腺癌、血清CEA升高和病灶同侧纵隔淋巴结多站转移的NSCLC,推荐行病灶对侧或斜角肌前淋巴结活检,以排除N3病变,为最优化的多学科治疗提供依据。
Objective: To investigate and screen out the clinical indications for mediastinal microscopy in patients with N3 lymph nodes of non-small cell lung cancer (NSCLC). Methods: Eighty-nine patients with stage Ⅰ-ⅢA NSCLC underwent thoracotomy underwent mediastinoscopy. Among them, 12 cases were treated with right dexillary muscle biopsy and 10 cases with anterior mediastinum dissection to examine the pathological changes of N3 lymph nodes. Results: After mediastinoscopy, 9 cases were found to be unsuitable for thoracotomy, including 3 cases of right-sided mesangial lymph node metastasis and 6 cases of contralateral mediastinal lymph node metastasis. Statistical analysis showed that the incidence of N3 in lung adenocarcinoma group was higher than that in non-adenocarcinoma group (P <0.05), and the incidence of N3 in serum CEA level was higher than that in normal group (P <0.05) The incidence of N3 in the metastasis group was higher than that in the ipsilateral single-site metastasis group (P <0.05). Conclusion: Lung adenocarcinoma, serum CEA elevation and ipsilateral mediastinal lymph node multi-site metastasis in NSCLC recommend the lesion contralateral or beveled myofascial lymph node biopsy to exclude N3 lesions, to provide the basis for the optimal multidisciplinary treatment.