Hubbard Matthew O, Schroeder Carsten, Linden Philip A
Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA.
Surg Laparosc Endosc Percutan Tech. 2011 Apr;21(2):111-5. doi: 10.1097/SLE.0b013e31821a3cb0.
A retrospective review was performed of all patients with upper lobe non-small cell lung cancers to assess the use of thoracoscopy in determining chest wall invasion in patients with lung cancers abutting the first rib, but without overt radiographic invasion. Of the 12 patients with tumors abutting the first rib without overt radiographic invasion, thoracoscopy was able to correctly determine chest wall invasion in 8 patients. There was no significant morbidity related to thoracoscopy. Large tumor size did not preclude thoracoscopic staging, whereas dense adhesions did limit the use of staging thoracoscopy. Patients with invasion by thoracoscopy were able to begin radiation or chemotherapy much sooner (median 22.3 d) than patients requiring thoracotomy (median 60 d). The routine use of staging thoracoscopy in all tumors abutting the first rib without overt radiographic evidence of invasion accurately identified apical chest wall involvement in 8 of 12 patients. With this strategy, unnecessary neoadjuvant treatment and futile thoracotomy may be avoided.
对所有上叶非小细胞肺癌患者进行了一项回顾性研究，以评估胸腔镜检查在确定与第一肋骨相邻但无明显影像学侵犯的肺癌患者胸壁侵犯情况中的应用。在12例与第一肋骨相邻且无明显影像学侵犯的肿瘤患者中，胸腔镜检查能够正确确定8例患者的胸壁侵犯情况。与胸腔镜检查相关的并发症并不显著。肿瘤体积大并不妨碍胸腔镜分期，而致密粘连确实限制了分期胸腔镜检查的应用。经胸腔镜检查发现有侵犯的患者比需要开胸手术的患者能够更快地开始放疗或化疗（中位时间22.3天对60天）。对于所有与第一肋骨相邻且无明显影像学侵犯证据的肿瘤常规使用分期胸腔镜检查，在12例患者中有8例准确识别了胸壁顶部受累情况。采用这种策略，可以避免不必要的新辅助治疗和徒劳的开胸手术。
