扩大切除加广泛淋巴结清扫治疗T3～4N2M0期肺癌的体会与评价
吴熹李旭东刘志勇杨丹宁陈凡蒋佩明朱亚彬
目的总结已有外侵的巨大肺癌肿块（T3～4）及纵隔淋巴结阳性（N2）的手术切除经验观察远期疗效分析临床意义。方法例T3～4N2M0期肺癌肺叶切除时分别扩大切除外侵组织切除一侧整个纵隔胸膜及脂肪广泛清扫纵隔内淋巴结。结果肿瘤切除后打破了机体的免疫封闭状态3年生存率鳞癌达％腺癌为％。综合治疗组与单纯手术组相比35年生存率均较低差异无显著性（P＞）。纵隔淋巴结阳性的T3～4期肿瘤扩大切除广泛淋巴结清扫后再行综合治疗效果不佳。结论扩大切除加广泛淋巴结清扫治疗T3～4N2M0期肺癌降低了手术探查率提高了手术切除率但扩大手术指征仍需谨慎选择。
肺肿瘤／外科学；淋巴结切除术
ExperienceandevaluationofextendedresectionandlymphnodesdissectioninstageT3～4N2M0lungcancer
WUXiLIXudongLIUZhiyongetal．
SoutheastUniversityAffiliatedZhongDaHospitalNanjingChina
ObjectiveToreportourexperienceofsurgicaltreatmentforstageT3～4N2M0lungcancer．MethodsOnehundredthirtyonepatientswithlungcancerinstageT3～4N2M0weresurgicallytreatedbyex-tendedtumorresectionlymphnodesdissectionandresectionofipsilateralmediastinalpleuraandfattytissue．
ResultsThe3-yearsurvivalrateofpatientsinstageT3N2M0withsquamous-cellcarcinomaandadenocarcinomawas34％and18％respectively．ThatforstageT4N2M0patientswasonly13％and5％respectively．Thesur-vivalratewasnotimprovedinpatientswhoreceived