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肺癌跳跃式纵隔淋巴结转移的临床病理探讨

A clinic pathological study of skip metastases of the mediastinal lymph node in lung cancer

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【作者】 许金良于庆凯夏庆欣务森刘先本龙志强

【Author】 XU Jin-liang, YU Qing-kai, XIA Qing-xin, et al. Department of Thoracic Surgery, Henan Cancer Hospital, Zhengzhou 450008, China

【机构】 河南省肿瘤医院胸外科河南省肿瘤医院病理科河南省肿瘤医院胸外科 450008郑州450008郑州

【摘要】 目的 探索肺癌跳跃式纵隔淋巴结转移的病理特点 ,为合理施行淋巴结清除术提供可靠的理论依据。方法  1992年 10月至 1998年 6月 ,为 398例肺癌病人施行了根治性肺切除、规范淋巴结清除术 ,对其中 4 7例 ( 2 9 4 % )跳跃式纵隔转移淋巴结病例进行病理学研究。结果 各型或各叶肺癌中 ,跳跃式转移淋巴结分布最密集的部位依次是第 7、4、3、5组淋巴结 ,分别占 2 9 8%、2 4 5 %、14 9%与10 6 % ;就鳞癌与腺癌而言 ,肿瘤长径在 1cm以内者均无跳跃式淋巴结转移 ,跳跃式淋巴结转移率随长径增加而增加 ;低分化腺癌淋巴结转移率明显高于高分化者 (P <0 0 1) ;发生跳跃式淋巴结转移的肿瘤平均长径鳞癌与腺癌分别为 15 3mm与 9 1mm。结论 对肺癌淋巴结的廓清 ,切勿仅凭手触摸或靠肉眼观察淋巴结大小而盲目判定其是否转移或清除。除T1 中肿瘤长径 <1cm的鳞癌外 ,淋巴结的规范清除应重视其跳跃性 ,原则上必须包括同侧胸腔的肺门及上、下纵隔各组淋巴结 ,尤其要重视跳跃式淋巴结转移分布较密集区域 ,即右侧的第 3、4、7组与左侧的第 4、5、7组淋巴结

【Abstract】 Objective To investigate the pathologic characteristics of skip metastases of mediastinal lymph node in lung cancer. Methods Of 398 lung cancer patients who underwent radical resection and extensive lymph node dissection. 47 patients were diagnosed as with skip N 2 metastases, and their mediastinal lymph nodes were analyzed. Results The skip N 2 metastases of lung cancer appeared as single group or multi-group. The commonest metastatic site was the 7th group lymph node (28.4%), then the 4th, 3rd and 5th group, rating 24.2%, 15.8% and 10.5%, respectively. For cases with squamous cell carcinoma or adenocarcinoma, no any skip N 2 metastasis occurred for the tumor less than 1 cm in diameter, for tumor greater than 1 cm in diameter, the skip N 2 metastasis increased with tumor size. The incidence skip N 2 metastasis of low-grade differentiated adenocarcinoma was significantly higher than high-grade differentiated adenocarcinoma (P<0.01). The mean diameters of mediastinal metastatic nodes were 15.3mm in squamous cell carcinoma, and 9.1mm in adenocarcinoma. Conclusion The complete removal of lymph nodes must include the hilar and upper and lower mediastinal nodes of homolateral thoracic cavity, especially in the concentrated metastasized areas, such as #3, #4, #7 in right lung cancer and #4, #5, #7 in left lung cancer.

  • 【文献出处】 中华胸心血管外科杂志 ,Chinese Journal of Thoracic and Cardiovascular Surgery , 编辑部邮箱 ,2004年06期
  • 【分类号】R734.2
  • 【被引频次】10
  • 【下载频次】89
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