原发性肺癌淋巴结清除临床价值的探讨  

Investigation of systemic lymphadenectomy during operation of lung cancer

作　　者：王伦青[1] 张哲[1] 尹志伊[1] 何宝亮[1] 唐国健[1] 

机构地区：[1]青岛市市立医院胸外科,山东青岛266001

出　　处：《中华肿瘤防治杂志》2008年第18期1408-1410,共3页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的:探讨肺癌淋巴结转移规律和分布特点,以期为手术时淋巴结系统清除提供参考。方法:对320例肺癌手术病例进行回顾性分析,其中一侧全肺切除患者68例,肺叶或双肺叶切除患者252例。术中按照Naruke肺淋巴结分布图进行了系统淋巴结清除,并进行病理检查。结果:淋巴结转移率为48.7%(156/320),其中N2转移率为35.6%(114/320)。第7和4组淋巴结转移最活跃,淋巴结转移受肿瘤部位、细胞类型和分化程度等因素影响,上叶肺癌纵隔淋巴结转移率明显高于中下叶,χ2=23.54,P<0.01;肿瘤越大,纵隔淋巴结转移率就越高,χ2=13.47,P<0.01;低分化癌纵隔淋巴结转移率比高分化癌高,χ2=5.36,P<0.05;腺癌纵隔淋巴结转移率比鳞癌高,χ2=18.09,P<0.01。结论:多数肺癌的淋巴结转移遵循由近及远、自下而上、由肺内经肺门再向纵隔的转移规律,许多纵隔淋巴结转移呈"跳跃式"。肺癌切除术时无论是哪一叶均须施行系统性胸内淋巴结清除。OBJECTIVE：To study the metastatic rule and disposition feature of thoracic lymph nodes,expecting to refer to systemic lymphadenectomy of lung cancer.METHODS：Three hundred and twenty patients with lung cancer performed with radical lobectomy or pneumonectomy and systemic lymphadenectomy were reviewed.All of them included radical lobectomy（single or double lobe） in 252 cases and pneumonectomy in 68 cases.Systemic lymphadenectomy refered by Naruke scattergram of pulmonary lymph nodes was performed during the operations and examined by pathology after the operations.RESULTS： The metastatic rates of lung lymph nodes and the mediastinal lymph nodes were 48.7%（156/320） and 35.6%（114/320） respectively.The seventh and the fourth groups of pulmonary lymph nodes were most actively in metabasis.The metastatic rate was correlated with the location of tumor,group and differentiation of tumor cells.Superior lobes had manifest higher mediastinal lymph nodes metastatic rate than middle lobes and lower lobes,χ^2=23.54,P〈0.01.The tumer with huger size also had higher mediastinal lymph nodes metastatic rate,χ^2=13.47,P〈0.01.The poorly differentiated tumer had higher mediastinal lymph nodes metastatic rate than well-differentiated tumer,χ^2=5.36,P〈0.05.The adenocarcinoma had higher mediastinal lymph nodes metastatic rate than squamous cell carcinoma,χ^2=18.09,P〈0.01.CONCLUSIONS： Most of neoplastic metastasis of lymph nodes spreads from proximal to distal areas,lower to upper regions,and from the lung to hilar then to the mediastinal.A few lymph node metastasises show a skipping pattern.It is necessary to perform systemic lymphadenectomy during pulmonary resection no matter which lobes of lung.

关 键 词：肺肿瘤/外科学 肺肿瘤/病理学 淋巴结清除术 

分 类 号：R734.2[医药卫生—肿瘤]