| 【Background and Purpose】Lung cancer is the most common malignancy in the world and in China,and it is also the malignant tumor with the highest morbidity and mortality.About 80% of the pathological types are non-small cell lung cancer.Current treatment methods for lung cancer include surgery,chemotherapy,radiotherapy,targeted drug therapy,and immunotherapy.For non-small cell lung cancer,radical resection is still the most important treatment.The overall survival rate after early lung cancer resection can be as high as 50%-60%.Since the 1990 s,anatomical lobectomy(VATS or open surgery)+systemic lymph node dissection has been considered the standard procedure for lung cancer surgery.However,systemic lymph node dissection has a higher incidence of complications than a smaller range of lymph node resections,such as prolonged surgery and anesthesia time,increased blood loss during surgery,postoperative arrhythmia,atelectasis,pulmonary infections,and lymphatic vessels.Increased incidence of hemorrhoids and prolonged postoperative hospital stay.Therefore,early lung cancer patients with a low rate of lymph node metastasis can replace systemic lymph node dissection with smaller lymph node dissection range,which has increasingly become a focus of debate in surgical procedures for lung cancer in recent years.This subject selected the patient’s own controlled study to perform sequential lymph node dissection on the surgical patient.That is,for the same case,lymph node sampling is first performed and frozen during surgery.Lung-specific lymph node dissections are then performed and marked in detail.The last systematic lymph node dissection was sent to the pathological examination after detailed labeling.The aim is to get the optimal range of lung cancer cleansing in different stages.【Method】1.Sequential lymph node dissection in operable stage Ia-IIb lung cancer patients.Lymph node sampling was performed first,and lymph nodes in the 10 th and 11 th groups of the ipsilateral lobes were resected for frozen operation.Then the corresponding lobes were excised,and lung-specific lymph node dissections were performed according to the lobe where the tumor was located.The lymph node dissection was performed in detail.Finally,systemic lymph node dissection was performed.Detailed labeling was followed by pathological examination.2.Use the SPSS19.0 statistical software package to process the general situation of the data,and use the pathological criteria of systemic dissection as the gold standard to evaluate the sensitivity,specificity,negative predictive value,and positive predictive value of lymph node sampling and specific lymph node dissection.,Yorden index(YI),accuracy.The exact data of the fisher’s count data line was tested by the percentage of probability,and the percentage was shown by P<0.05.There was statistical difference in the study.【Result】1.Based on pathological criteria after systemic dissection,sensitivity,specificity,negative predictive value,positive predictive value and accuracy of specific lymph node dissection are all 100%,Yonden index(YI)is 1;The specificity and negative predictive value of lymph node sampling are all 100%.Sensitivity,positive predictive value,accuracy,and Yonden index(YI)is 22.2%,72%,74.1%,and 22.2%.2.In this study,there was 1 case of metastatic mediastinal lymph node metastasis.3.There was no significant difference in tumor pathological type,tumor location,Lung adenocarcinoma typing,tumor markers CEA,CA-125,CYFRA21-1,NSE,SCC and lymph node metastasis(P>0.05);tumor size,tumor differentiation and lymph node metastasis There was a statistically significant difference(P<0.05).【Conclusion】1.For clinical stage Ia-IIb non-small cell lung cancer,specific lymph node dissection is not significantly different from systemic lymph node dissection in postoperative pathological N staging and superior to lymph node sampling.2.For early lung cancer diameter ≤2cm,specific lymph node dissection,lymph node sampling showed no significant difference in pathological N staging and systemic lymph node dissection.3.The phenomenon of metastatic mediastinal lymph node metastasis can be seen in early clinical lung cancer.4.The degree of tumor differentiation,tumor size and lymph node metastasis are related. |
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