Application value of preoperative enhanced multi-slice spiral CT scan in the surgical treatment for elderly patients with non-small cell lung cancer
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摘要:
目的 探究术前多层螺旋CT增强扫描在老年非小细胞肺癌（NSCLC）患者手术治疗中的应用价值。 方法 回顾性分析2020年1月~2021年3月在本院接受治疗的120例老年NSCLC患者的临床资料，所有患者均接受多层螺旋CT增强扫描，分析多层螺旋CT诊断NSCLC的TNM分期、淋巴结转移与病理结果一致性，比较不同手术方式患者的手术情况和术后并发症发生情况。 结果 术前多层螺旋CT增强扫描诊断T分期、N分期、淋巴结转移和临床分期的准确率分别为89.17%、90.83%、87.10%、88.33%，与病理结果一致性较高（Kappa=0.789、0.792、0.787、0.776）。120例NSCLC患者中，98例接受手术治疗，其中57例患者接受肺楔形切除术+淋巴结清扫术，41例患者接受全肺叶切除术+淋巴结清扫术；接受肺楔形切除术患者的手术时间明显短于接受全肺叶切除术的患者，术中出血量和淋巴结清扫数量少于接受全肺叶切除术的患者，并发症发生率发生率明显低于接受全肺叶切除术的患者（P < 0.05）。 结论 多层螺旋CT增强扫描对老年NSCLC术前分期、淋巴结转移情况的诊断均具有较高准确度，可为手术方式的选择提供一定指导。 Abstract:Objective To explore the application value of preoperative enhanced multi-slice spiral CT scan in the surgical treatment for elderly patients with non-small cell lung cancer (NSCLC). Methods We retrospectively analyzed the clinical data of 120 elderly patients with NSCLC treated in the hospital between January 2020 and March 2021. All patients were subjected to enhanced multi- slice spiral CT scan. The consistency between multi- slice spiral CT and pathological results in diagnosing TNM stage and lymph node metastasis of NSCLC were analyzed. The operative conditions and postoperative complications of patients treated by different surgical methods were compared. Results The accuracy rates of preoperative enhanced multi-slice spiral CT scan in the diagnosis of T stage, N stage, lymph node metastasis and clinical stage were 89.17%, 90.83%, 87.10%, and 88.33%, which were consistent with pathological results (Kappa=0.789, 0.792, 0.787, 0.776). In the 120 patients with NSCLC, 98 received surgical treatment, including 57 patients undergoing pulmonary wedge resection and lymph node dissection, and 41 patients undergoing total lobectomy and lymph node dissection. The operation time of patients undergoing pulmonary wedge resection were significantly shorter than those of patients undergoing total lobectomy. The intraoperative blood loss and number of lymph nodes removed were less or smaller than those of patients undergoing total lobectomy, and the incidence of complications was significantly lower than that in patients undergoing total lobectomy (P < 0.05). Conclusion Enhanced multi- slice spiral CT scan has high accuracy in the diagnosis of preoperative stage and lymph node metastasis of NSCLC, thereby providing guidance for the selection of surgical methods. -
Key words:
- non-small cell lung cancer /
- elderly patient /
- multi-slice spiral CT /
- enhanced scan /
- surgical method
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图 1 典型病例多层螺旋CT增强扫描图像
A: 患者男, 50岁, 因体检发现右肺上叶结节入院, 行肺楔形切除术+淋巴结清扫术，术后常规病理检查诊断为腺癌; B: 患者男, 75岁, 因体检发现右肺上叶结节入院, 行全肺叶切除术+淋巴结清扫术, 术后常规病理检查诊断为腺癌.
Figure 1. Enhanced multi-slice spiral CT scan images of a typical case.
表 1 多层螺旋CT增强扫描诊断患者T分期与手术-病理T分期结果比较
Table 1. Comparison between T staging by enhanced multi-slice spiral CT scan and surgical-pathological T staging (n)
CT诊断 n 手术-病理T分期 准确率（%） T1 T2 T3 T4 T1 20 17 3 0 0 85.00 T2 73 0 69 4 0 94.52 T3 19 0 4 14 1 73.68 T4 8 0 0 1 7 87.50 合计 120 17 76 19 8 89.17 
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表 2 多层螺旋CT增强扫描诊断患者N分期与手术-病理N分期结果比较
Table 2. Comparison between N staging by enhanced multi-slice spiral CT scan and surgical-pathological N staging (n)
CT诊断 n 手术-病理T分期 准确率（%） N0 N1 N2 N0 55 50 5 0 90.91 N1 32 0 29 3 90.63 N2 33 1 2 30 90.91 合计 120 51 36 33 90.83
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表 3 多层螺旋CT增强扫描诊断患者淋巴结转移与病理结果比较
Table 3. Comparison between the diagnostic results of enhanced multi-slice spiral CT scan and pathological results for lymph node metastasis (n)
CT诊断 手术-病理诊断 合计 有淋巴结转移 无淋巴结转移 有淋巴结转移 27 6 33 无淋巴结转移 4 83 87 合计 31 89 120
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表 4 多层螺旋CT增强扫描诊断患者临床分期与病理结果比较
Table 4. Comparison between the diagnostic results of enhanced multi- slice spiral CT scan and pathological results for clinical stage (n)
CT诊断 n 手术-病理临床分期 准确率（%） ⅠA ⅠB ⅡA ⅡB ⅢA ⅢB ⅠA 34 30 3 1 0 0 0 88.24 ⅠB 29 2 26 1 0 0 0 89.66 ⅡA 21 1 1 19 0 0 0 90.48 ⅡB 14 0 0 1 12 1 0 85.71 ⅢA 12 0 0 0 2 10 0 83.33 ⅢB 10 0 0 0 0 1 9 90.00 合计 120 33 30 22 14 12 9 88.33
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表 5 不同手术方式NSCLC患者手术指标及术后并发症发生情况比较
Table 5. Comparison of surgical indicators and postoperative complications in patients with NSCLC treated by different surgical methods (Mean±SD)
指标 肺楔形切除术（n=57） 全肺叶切除术（n=41） t/χ2 P 手术时间（min） 106.74±11.18 113.25±16.34 2.379 0.019 术中出血量（mL） 64.37±8.94 86.54±10.22 11.403 < 0.001 淋巴结清扫数量（个） 3.12±1.03 6.54±2.31 8.858 < 0.001 并发症发生率[n (%)] 6（10.53） 11（26.83） 4.421 0.036
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