| Only in more than 100 year ago, a lung cancer still a rare disease,the whole world reported only about 200 example at that time, andhard to make the final diagnosis in the survival time. Along with theprogress of the industry economy, the outbreak rate of the lung cancerraises year by year, in most developed country, although the outbreakrate of the lung cancer descend year by year, still was a male tumor offirst, the 2 or 3rd of the female tumor. In the past decade, the treatmentfor lung cancer has made great progress, from the operational methodsexploration to improvement of the radiotherapy, from the lung cancerchemotherapy new development of the medicine to match the programof the chemotherapy and the emergence of biological treatment,during this process it was realized that the treatment of lung cancerhas its limitations means, therefore take surgical operation as thecomprehensive treatment of the lord to have become a popularresearch topic at present. But along with the extension of indication oflung cancer surgical operation the microscopic residual disease (MRD)raises. MRD is the main cause of the complications of the stump ofthe bronchus or the anastomotic stoma, it is also one of the factorsaffecting patient prognosis. How to avoid this is a problem duringclinical surgical practices. Despite there are long-term survival ofpatients with MRD reported, undoubtedly the patients with MRD hadbad prognosis. MRD means the operation is not the radical cure.Domestic and foreign scholars analyze the reason of MRD andhow to reduce or avoid it from the following aspects: pathologicaltype of the lung cancer, pathological stage of the lung cancer,operational methods of lung cancer and the distance between themargin and the tumor. Domestic and foreign scholars' study forpathological types showed different histopathological types dealingwith cancer on the length bronchial wall, adenocarcinoma had thelongest average length, squamous cell carcinoma shortest, there aresignificant difference. But squamous cell carcinoma has higherincidence of MRD than adenocarcinoma;for pathological stage studyfound that T phased higher, the greater diameter of the tumor andcentral type lung cancer and far more prone to local or distantmetastasis,the rate of MRD is gradually rising;For the operationalmethods of lung cancer sleeve pneumonectemy can meet with theentire lung excision similar to the total removal of tumor, and retainedmore functional lung organizations, is a more ideal surgical methodfor the patients that the cancer invasion of bronchi lobares or mainbronchus, heart function incomplete not withstanding entire lungexcision. In surgical options, from the patients own specific conditionsand choose the most appropriate way to avoid their own preferenceson the basis of choice of doctors, the only way to achieve goodtreatment effect, which can make the effective reduction of MRD. Tostudy the relevant factors of MRD, this period of 2002-2005 in JilinUniversity 1st hospital tumor excision of 153 cases of non-small celllung cancer patients for retrospective analysis. Analyze the followingaspects: pathological type of the lung cancer, pathological stage of thelung cancer, the location of tumor and operational methods of lungcancer. There are 21 cases with MRD, accounting for 13.7% of allcases. Their fate is different pathological types of lung cancerincidence different, squamous cell carcinoma incidence of 15.8%,adeno-squamous carcinoma incidence of 12.5%, adenocarcinomaincidence of 11.3%. The incidence of MRD in different pathologicalstage is different. 0% for â… a, 5.7% for â… b, 6.7% for â…¡a, 26.8% forâ…¡b, 20% for â…¢a, 0% for â…¢b, 0% for IV. The incidence of MRD indifferent operational methods, the entire lung excision is 14.3%,pulmonary lobectomy is 15.7%, sleeve pneumonectemy is 33.3%wedge excision is 3.4%.Towards pathological types, pathological stage and the locationof lung cancer we used regression analysis, and dealing with the use ofSAS statistical software. And surgical methods for the analysis of aseparate. Regression analysis revealed MRD related with pathologicaltypes and pathological stage, unrelated with the location of lungcancer. Therefore, we should pay attention to the pathological types ofcases for squamous cell carcinoma, avoiding the occurrence of MRD.Non-small cell lung cancer patients with â…¢stage who completesurgical removal of tumors greater difficulties can be considered forneoadjuvant chemotherapy (NCT), which is helpful to complete theremoval of tumors for surgery and reduce the possibility of MRD. Thetwo basic criteria for the treatment of lung cancer, is to try to excisethe whole tumor, and the other is to keep more healthy functionalorganizations. When these two criteria are also carefully consideredsuccessively and, if the two can not combine, in patients whose heartfunction is tolerable, accept the first principle and give up the secondprinciple. Specifically if the pulmonary lobectomy (including doublelobes or sleeve pneumonectemy) can not get radical cure, we would beto excise the entire lung, at the expense of some organizations stillhave functional lungs so. However, we must also prevent anothertendency to test technologies, originally pulmonary lobectomy caneradicate the tumor is done sleeve pneumonectemy, wasted time andincreased the possibility of surgery complications. Therefore for thechoice of surgery, from the specific conditions of the patientsthemselves, the selection of the most appropriate way to avoid theirown preferences on the basis of choice of doctors, that is the only wayto achieve good treatment effect, reduce the incidence of MRD.Sending bronchial margin to rapidly chilled pathological examinationplays an important role of reducing the incidence of MRD. But takinginto account the patients currently in the domestic medical costs,reduce the financial burden of patients, frozen pathologicalmicroscopic examination of the implementation of certain restrictions,and this is causing domestic the high incidence of MRD. We proposesending bronchial margin to rapidly chilled pathological examinationas surgical treatment of lung normative steps. |
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