【摘要】 目的　从病理学角度探索合理选择肺癌手术方式的理论依据。方法　对 3 98例肺癌根除性肺切除标本近侧支气管及肺门纵隔淋巴结进行病理学研究。结果　①癌直接沿近侧支气管壁粘膜层、粘膜下层或多层面侵袭蔓延 ,分别占 9.3 %、2 1.8%与 68.9%。 96.4%的癌侵袭是发生在距瘤缘 1.5cm以内的管壁上。其侵袭距离与肺癌病理类型、侵袭方式及TNM分期有密切关系。②癌细胞经转移淋巴结间接侵袭近侧支气管壁外膜或软骨层 2 2例 ,其中N1者侵袭叶支气管壁 3例 ,N2 者侵袭主支气管壁 19例 ,以腺癌为突出 ,尤其低分化腺癌N2 转移率与侵袭率均显著高于高分化者 (P <0 .0 1,P <0 .0 1)。结论　合理选择肺癌手术方式的病理学原则是确保支气管切端距瘤缘的安全界限 >1.5cm ;即使是周围型肺腺癌 ,也应重视淋巴结转移对支气管壁的侵袭性并主动清除同侧肺门及上、下纵隔淋巴结。更多还原

【Abstract】 Objective To investigate pathologically the characteristics of proximal bronchial invasion of lung cancer, and to provide the theoretic basis for the selection of a proper operation mode. Methods A total of 398 patients with lung carcinoma underwent radical pulmonectomy and systematic lymphadenectomy. The proximal bronchi and the hilar and mediastinal lymph nodes of their operatively resected specimens were selected for pathological study. Results ①The direct invasion of cancerous cells through mucous, submucous or multiple layers was the most frequent way during lung cancer spread, rating 9.3%, 21.8% and 68.9% respectively. 96.4% of the cancerous invasion occurred at the proximal bronchial wall less than 1.5 cm apart from the cancer margin. The extension of invasion correlated with the histopathologic type of cancer, mode of invasion and TNM classification. ②The cancer infiltration by the nodes metastasizing into the bronchus wall (bronchial external tunica or cartilage) was also an important way for the cancer to spread, especially in adenocarcinoma. The poor differentiated adenocarcinoma has significantly higher metastatic rate and infiltration rate than the well differentiated ( P <0.01, P <0.01). There were 22 such cases, including 3 of lobar bronchus wall invaded by N1 metastasis and 19 of main bronchus wall by N2 metastasis. Conclusion For radical removal of tumor, the key point for selecting a rational operation mode is to keep a distance of 1.5 cm or more between the excision margin of the bronchus and the tumor, to pay attention to the bronchial wall invasion caused by the metastatic lymph nodes, even in peripheral adenocarcinoma, and to dissect extensively and completely the lymph nodes of the hilar and upper and lower mediastinum at the homolateral thoracic cavity.更多还原