肺癌胸内淋巴结转移特点及临床意义

【作者】 高峰； 王瑞； 郭阳； 张泽峰； 齐战；

【机构】 河北医科大学第四医院暨河北省肿瘤医院胸外科；

【摘要】 目的:探讨原发性肺癌胸内淋巴结转移特点及转移方式,为确定肺癌术中淋巴结廊清范围提供依据。方法: 按Naruke肺癌淋巴结分布图对400例肺癌病人施行了手术切除及广泛肺门、叶间、纵隔淋巴结廓清术,并进行临床病理分析。结果:清除淋巴结2810组。N1淋巴结转移率为22． 1％,N2淋巴结转移率18．1％。T1T2T3间淋巴结转移率差异非常显著(P<0．01)。T1鳞癌无N2转移。N2转移率在鳞癌、腺癌、小细胞癌、大细胞癌分别为32．1％,46．1％,47．0％, 及51．0％,跳跃式转移占N2转移的52．6％。N2阳性上叶肺癌下纵隔转移占16．1％,下叶肺癌上纵隔转移占54．3％。肺原发肿瘤大小与淋巴结转移之间无明显关系。40岁以下下患者淋巴结转移度高达86％,显著高于其它年龄组P<0．01,而其它组之间无明显差异。结论:肺癌淋巴结转移具有多发性,跳跃性。瘤体增大及外侵淋巴结转移频度增加。腺癌比鳞癌转移频度高。任何部位的肺癌均可跨区域纵隔转移。年轻肺癌患者的淋巴结转移度高,特别是跳跃性N2的转移度。系统性胸内淋巴结廓清在肺癌术中应常规应用。更多还原

【Abstract】 Objective: To investigate the characteristics and patterns of lymph node metastasis in lung canner, and to provide evidence for determining range of lymph node dissection. Methods: 400 patients with lung canner underwent surgery plus extensive dissection of hilar ,inter lobor and mediaatinal noodes according to the grouping system proposed by Naruke . Results: A totol of 2810 groups of lymph nodes were removed .Metaststic rate of N1 and N2 nodes were 22.1% and 18.1%.Significant difference of lymph node metastasis existed among T1,T2 and T3 patient .No cancer metastasized to mediastium in T1 squamous carcinoma.N2 metaststic rate for squamous carcinoma, adenocarcinma,small cell carcinoma and large cell carcinoma were 32.1%,46.1%,47.0% and 51.0%, respectively . Sloitary metastatic nodes accounted for 52.6% of N2 nodes. 16.1% N2-positive cancer in upper lobes metastasized to lower mediastium,while 543% of N2 - positive lobes spread to upper mediastium. Conclusion: Solitary and multiple metastasis are the characteristic of lymph nodes metastasis in adenocarcinoma occurs more frequently than in squamous carcinoma .Tumor at any site can me-tastasize to distant mediastium. Execpt for T1 squamous carcinoma ,radical surgery can be achieved only by extensive dissection of intrapulmonary and ipsilateral medias-tinal lymph nodes.更多还原