方德康 张大为 张汝刚 汪良骏 张德超 100021 北京，中国医学科学院中国协和医科大学肿瘤研究所肿瘤医院胸外科 中华肿瘤杂志 1999 0 21 4


    关键词：肺肿瘤/外科学；肿瘤转移；淋巴转移；肿瘤复发 期刊 zhzlzz 0 临床研究 fur -->


    

【摘要】 目的 探讨肺癌根治术后复发、转移的特点，为术后复查和治疗提供依据。方法 采用STATA统计软件，建立病例资料数据库，并进行统计分析。生存率采用寿命表法计算，不同分组之间差异的显著性采用logrank检验。两组间复发、转移率差异的显著性用χ² 检验。结果 术后局部复发率鳞癌高于腺癌(P<0.05),其他病理类型之间差异无显著性。袖式肺叶切除术、肺叶切除加邻叶部分切除术的局部复发率高于其他术式(P<0.05)。淋巴结转移的发生率腺癌高于鳞癌(P<0.05)。各器官血行转移发生的频率依次为：肺、骨、脑、肝、皮下及肾上腺。血行转移的发生率腺癌及大细胞癌均高于鳞癌(P<0.01)。淋巴结转移或血行转移后积极治疗可以提高生存率(P<0.01)。结论 对于跨叶性病变在肺功能许可的前提下应行多叶切除，避免做肺叶切除加受侵邻叶部分切除术。袖式肺叶切除术要尽量增加支气管切缘长度，以减少局部复发。发现淋巴结或血行转移后给予积极治疗，可以显著提高生存率。

Study of recurrence andmetastasis after radical resection of carcinoma of the lung

FANG Dekang, ZHANG Dawei, ZHANG Rugang, etal. Department of Thoracic Surgery, Cancer Institute (Hospital), Chinese Academy ofMedical Sciences, Peking Union Medical College, Beijing 100021

【Abstract】 Objective Tostudy the characteristics of recurrence and metastasis following radical resection ofcarcinoma of the lung. Methods A total of 1 229 cases of radicallyresected lung cancer was statistically analyzed using STATA software. The survival ratewas estimated using life table method. Comparisons of survival in each group were madeaccording to the log rank test. The differences in rate between groups was assessed by χ² test. Results Recurrence rate was found higher in squamous-cellcarcinoma than in adenocarcinoma. It was also higher in sleeve resection and partialresection than in other resection modes (P<0.05). The rate of lymph node metastasis washigher in adenocarcinomas than in squamous-cell carcinoma (P<0.05). Lung, bone, brain,liver, subcutis, and adrenal glands were the common resorts of metastasis, in decreasingorder of frequency. Metastatic rate was the lowest in squamous-cell carcinoma. Activetherapy can still improve the survival even when recurrence and metastasis occurred. Conclusion Itis recommended to avoid partial resection for the invaded adjacent lobe whenever patient′scondition can stand multilobectomy. It is necessary to assure resection margin length whensleeve resection is performed in order to reduce recurrence. Active therapy can improvesurvival of patients with recurrence and metastasis.

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