肺癌胸内淋巴结转移规律及其临床意义  

Clinical analysis of the characteristics of thoracic lymph node metastasis in lung cancer: A report of 318 cases

作　　者：王长利[1] 尤健[1] 孙承军[1] 姜宏景[1] 张熙曾[1] 

机构地区：[1]天津医科大学附属肿瘤医院肺部肿瘤外科,300060

出　　处：《中国肺癌杂志》2004年第5期438-441,共4页Chinese Journal of Lung Cancer

摘　　要：目的　探讨肺癌胸内淋巴结转移的规律。方法　对 3 18例肺切除加淋巴结廓清术患者进行临床病理分析。结果　 3 18例患者共清除淋巴结 15 3 4组 ,其中转移淋巴结 2 90组。胸内淋巴结转移率为5 8.5 % ( 186/3 18) ,其中N1转移率为 2 7.0 % ( 86/3 18) ,N2 转移率为 3 1.4% ( 10 0 /3 18)。距肺根部最近的 11、10、7、4区淋巴结转移频度最高。发生跳跃式N2 转移 46例 ,占 14 .5 % ,其中上叶肺癌仅出现上纵隔跳跃式淋巴结转移 ;下叶肺癌及右中叶肺癌则可出现上、下纵隔跳跃式淋巴结转移。术前胸部CT扫描肺门及纵隔淋巴结肿大者中 ,术后病理报告阳性者占 48.2 % ;CT扫描淋巴结阴性者中 ,术后病理报告阳性者占 2 2 .4%。结论　上叶肺癌应常规清扫肺门、隆凸下及上纵隔淋巴结 ,如果无隆凸下淋巴结转移可不清扫 8、9区 ;下叶及右中叶肺癌 ,无论有无肺门或隆凸下淋巴结转移 ,均应广泛清扫上、下纵隔淋巴结。Objective To investigate the clinical characteristics of thoracic lymph node metastasis in lung cancer. Methods Three hundred and eighteen patients with lung cancer underwent pneumonectomy or lobectomy and lymphadenectomy from Jan 2000 to Jan 2002. Results A total of 1534 groups of lymph nodes were removed. Metastatic frequency of thoracic lymph nodes was 58.5% (186/318), in which N1 was 27.0% (86/318), N2 was 31.4% (100/318). There were higher frequencies of lymph node metastasis in 4, 7, 10, 11 regions around the root of lung. Among the skipping N2 metastasis (14.5%, 46/318), upper lobe cancer led to only upper mediastinal lymph node metastasis, however, lower or right middle lobe cancer caused both upper and lower mediastinal lymph node metastasis. Of the patients with swelling hilar and mediastinal lymph nodes reported by preoperative CT scan, only 48.2% were confirmed with lymph node metastasis by postoperative histopathology; while 22.4% of the patients with normal size lymph nodes had lymph node metastasis.Conclusion If there is no hilar and inferior carinal metastatic lymph node in patients with upper lobe cancer, the lower mediastinal lymph node dissection might not be necessary. But systematic mediastinal lymph node dissection should be performed in patients with lower lobe or right middle lobe cancer whether there is hilar or inferior carinal metastatic lymph node or not. The extent of lymph node dissection should not depend on the results of preoperative chest CT scan.

关 键 词：淋巴结转移 上叶肺癌 肺门 隆凸 前胸 纵隔淋巴结 术后病理报告 频度 

分 类 号：R734.2[医药卫生—肿瘤] R735[医药卫生—临床医学]