临床Ia期非小细胞肺癌淋巴结清扫范围的探讨  

Appropriate Extent of Lymph Node Dissection for Clinical Ⅰa Stage Non-small Cell Lung Cancer

作　　者：潘铁成[1] 郑智[1] 李军[1] 陈涛[1] 刘立刚[1] 魏翔[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院心胸外科肺癌临床治疗和研究中心,湖北武汉430030

出　　处：《癌症》2007年第3期303-306,共4页Chinese Journal of Cancer

摘　　要：背景与目的:肺癌手术中淋巴结的处理方式在学术界一直存在争论,尤其是早期非小细胞肺癌(non-small cell lung cancer,NSCLC)患者。我们通过研究淋巴结转移规律来探讨Ⅰa期NSCLC手术中淋巴结清扫的合理范围。方法:41例临床Ⅰa期NSCLC患者进行肺叶切除及纵隔淋巴结系统清扫,将淋巴结行病理切片,HE染色明确是否有癌转移。研究肺门、纵隔淋巴结转移规律。结果:共清扫淋巴结295组,转移42组(占14.2%),其中肺门淋巴结转移33组,纵隔淋巴结中转移9组。纵隔淋巴结转移中第7站淋巴结出现转移4例,第5、9站淋巴结出现转移各2例,第4站淋巴结出现转移1例。上叶肿瘤转移包括5、7站淋巴结,中下叶肿瘤转移包括4、7、9站淋巴结。结论:临床Ⅰa期非小细胞肺癌的肺门、纵隔淋巴结转移遵循区域性淋巴结引流规律,可行区域选择性淋巴结清扫,即上叶肿瘤在无肺门或隆突下淋巴结转移时可只清扫上纵隔淋巴结而无须清扫下纵隔淋巴结,中下叶肿瘤无论有无肺门或隆突下淋巴结转移都需要进行上下纵隔淋巴结清扫。BACKGROUND ＆ OBJECTIVE; There is no agreement on the appropriate extent of lymph node dissection for lung cancer, especially for early non-small cell lung cancer （NSCLC）. This study was to explore the appropriate extent of lymph node dissection for early NSCLC by investigating the metastasis regulations of hilar and mediastinal lymph nodes. METHODS. Forty-one clinical I a stage NSCLC patients received Iobectomy and systematic mediastinal lymphadenectomy in Tongji Hospital from Jan. 2002 to Dec. 2004. The removed lymph nodes were subjected for pathologic examination. The metastasis regulations of hilar and mediastinal lymph nodes were investigated. RESULTS. A total of 295 groups of lymph nodes were removed. Among them, 42 （14.2%） groups had metastasis, including 33 groups of hilar lymph nodes and 9 of mediastinal lymph nodes. Four patients had mediastinal lymph node metastasis in the 7th station, 2 in the 5th station, 2 in the 9th station, and 1 in the 4th station. The patients with tumors in the upper lobe had metastasis in the 5th or 7th station lymph nodes; the patients with tumors in the middle or lower lobe had metastasis in the 4th, 7th, or 9th station. CONCLUSIONS： The metastasis regulations of hilar and mediastinal lymph nodes in I a stage NSCLC is accordant to regional lymph node drainage regulations. Selective regional lymph node dissection might be applied in these patients, that is, upper mediastinal lymph node, not lower mediastinal lymph node, should be removed when the tumor is in the upper lobe without hilar or subcarinal lymph node metastasis, while all mediastinal lymph nodes should be removed when the tumor is in the middle or lower lobe.

关 键 词：肺肿瘤/外科手术 癌 非小细胞性 淋巴结清扫术 

分 类 号：R734.2[医药卫生—肿瘤]