支气管肺癌诊治规范PPT学习教案

1、会计学1支气管肺癌诊治规范支气管肺癌诊治规范2第1页/共22页3第2页/共22页4第3页/共22页5第4页/共22页6第5页/共22页7第6页/共22页8第7页/共22页9第8页/共22页10第9页/共22页11第10页/共22页12第11页/共22页13LUNG CANCERStage I diseaseLUNG CANCERStage I disease 2 2 cmcmORORORORN0: No lymph node involvementN0: No lymph node involvementNo lobarNo lobarbronchusbronchusinvolvementin

2、volvementT T 3 cm3 cmStage IAStage IAT1T1N0N0M0M0Stage IBStage IBT2T2N0N0M0M0T T 3 cm3 cmT + visceral pleuraT + visceral pleurainvolvedinvolvedT +T + atelectasisatelectasis第12页/共22页14II期肺癌期肺癌 NSCL：手术为首选手术为首选 术后处理：术后处理：推荐化疗推荐化疗SCLC ：化疗化疗+手术手术/放疗放疗+手术手术LUNG CANCERStage II diseaseLUNG CANCERStage II di

3、sease 2 2 cmcmOROROROR N1: Intrapulmonary and/orN1: Intrapulmonary and/or hilar hilar nodes involved nodes involvedNo lobarNo lobarbronchusbronchusinvolvementinvolvementT T 3 cm 3 cm Stage IIAStage IIAT1T1N1N1M0M0 Stage II BStage II BT2T2N1N1M0M0T3 T3 N0 M0 N0 M0T T 3 cm3 cmT + visceral pleuraT + vi

4、sceral pleurainvolvedinvolvedT +T + atelectasis atelectasis第13页/共22页15LUNG CANCERStage IIIA diseaseLUNG CANCERStage IIIA disease 2 2 cm 2 cmT2T2ORORORORORORORORT1T1N1:N1: peribronchial peribronchial or or ipsilateral hilar ipsilateral hilarT T 3 cm 3 cmNo lobarNo lobarbronchus involvementbronchus in

5、volvementT T mediastinal mediastinal pleura pleura (or pericardium) (or pericardium)T T chest wall chest wall (or diaphragm) (or diaphragm)T3T3N1N1M0M0T3T3N2N2M0M0T1 T1 N2N2M0M0T2T2N2N2M0M0T T 3 cm 3 cmT + visceral pleuraT + visceral pleurainvolvedinvolvedT +T + atelectasis atelectasisN2:N2: ipsilat

6、eral mediastinal ipsilateral mediastinal and and subcarinal subcarinal第14页/共22页16LUNG CANCERStage IIIB diseaseLUNG CANCERStage IIIB diseaseAny T, N3, M0Any T, N3, M0Any N, T4, M0Any N, T4, M0ScaleneScaleneSupraclavicularSupraclavicularN3: lymph nodes involvedN3: lymph nodes involvedT4:T4: mediastina

7、l mediastinal involvement involvementAny TAny TAny NAny NT4T4第15页/共22页17LUNG CANCERLocal and distal spreadLUNG CANCERLocal and distal spreadBrainBrainDraining lymph nodesDraining lymph nodesLiverLiverAdrenalsAdrenalsBoneBoneIV期肺癌期肺癌治疗次序治疗次序化疗为主化疗为主选择性放疗选择性放疗 同位素治疗、同位素治疗、支持、对症支持、对症第16页/共22页18医院医院级别级别

8、病例病例规规 范范基基 本本 规规 范范不不 规规 范范无无 法法 评评 价价病例病例百分比百分比 病例病例百分比百分比 病例病例百分比百分比病例病例百分比百分比三级三级177177545430.5130.51989855.3755.3713137.357.3512126.786.78区级区级65165126926941.3241.3226726741.0141.01797912.1412.1436365.535.53县级县级312312959530.4530.4515415449.3649.36535316.9916.9910103.213.21合计合计1140114041841836.67

9、36.6751951945.5345.5314514512.7212.7258585.095.09第17页/共22页19ICD-ICD-9 9瘤别瘤别例数例数规规 范范基基 本本 规规 范范不不 规规 范范无无 法法 评价评价 病例病例百分百分比比病例病例百分比百分比病例病例百分比百分比病例病例百分比百分比150150食管癌食管癌2525242468.5768.578 822.8622.863 38.578.57151151胃癌胃癌284284858529.9329.9313013045.7745.77444415.4915.4925258.808.80153153结肠癌结肠癌16116178

10、7848.4548.45525232.2932.29242414.9114.917 74.354.35154154直肠癌直肠癌141141474731.9731.97636344.6844.68242417.0217.027 74.964.96155155肝癌肝癌8383565667.4767.47171720.4820.489 910.8410.841 11.211.21162162肺癌肺癌156156282817.9517.9510310366.0366.03191912.1812.186 63.853.85174174乳腺癌乳腺癌220220919141.3641.3610810849.0949.0912125.465.469 94.094.09合计合计10801080* *40940937.8737.8748148144.5444.5413213212.2212.2258585.375.37第18页/共22页20第19页/共22页21医院级别医院级别病例数病例数明确分期明确分期未作分期未作分期错误分期错误分期病例病例百分比百分比病例病例百分比百分比病例病例百分比百分比三级医院三级医院177177515128.8128.8111111162.7162.7115158.488.48区级医院区级医院591591245245