肺癌淋巴结转移的临床分析  

Clinical study of lymph node metastasis in lung cancer

作　　者：李玉嶂[1] 崔翰文[1] 赵雨松[1] 

机构地区：[1]黑龙江省医院胸外科,哈尔滨150001

出　　处：《中国医药》2009年第10期770-771,共2页China Medicine

摘　　要：目的探讨原发性肺癌淋巴结转移频度、分布范围及其特点。方法对416例肺癌患者施行手术切除，并按Naruke肺癌淋巴结分布图行广泛肺门、叶间及纵隔淋巴结廓清术。结果清除淋巴结2871组。N1淋巴结转移率为20．5％，N2淋巴结转移率15．8％。原发肺癌（T）分期T1、T2、T3间淋巴结转移率差异有统计学意义（P〈0．01）。N2转移在鳞癌、腺癌、大细胞癌及小细胞癌分别为31．3％、43．8％、61．9％及83．3％。鳞癌N2转移中68．3％为1组淋巴结，腺癌N2转移3组以上者占42．0％。跳跃式转移占N2转移的42．0％。N2阳性者上叶肺癌下纵隔转移占18．1％，下叶肺癌上纵隔转移占44．2％。结论肺癌淋巴结转移具有多发性、跳跃．陛特点。癌体增大及外侵与淋巴结转移频度呈正相关，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。只有广泛清除肺内、同侧纵隔淋巴结才能达到根治目的。Objective To investigate the frequency and feature of lymph nodes metastasis in lung cancer. Method Four hundred and sixteen patients with lung cancer underwent surgery plus extensive dissection of hilar, inter lobor and mediastinal nodes according to the Naruke grouping system. Results A total of 2871 groups of lymph nodes were removed. Metastatic rates of N, and N2 nodes were 20.5% and 15.8%. Significant difference of lympy nodes metastasis existed among T1 , T2 and T3 patients （P 〈0.01）. N2 metastatic in squamous carcinoma, adenocarcinoma, large cell carcinoma and small cell carcinoma were 31.3%, 43.8%, 61.9%, and 83.3% respectively. 68.3% of N2 metastatic nodes in squamous carcinoma localized in one single group. 42% of N2 meta- static nodes in adenocareinoma spreaded over 3 groups. Sloitary metastatic nodes accounted for 42% of N2 metastatic nodes. 18.1% of N2-positive cancer in upper lobes metastasized to lower mediastinum, but 44.2% of N2-positive cancer in lower lobes spread to upper mediastinum. Conclusion Solitary and multiple metastasis are the characteris- tic of lymph nodes metastasis in lung cancer. The frequency of metastasis increases with the growth and invasion of tumor Metastasis in adenocarcinoma occurs more frequently than in squamous carcinoma. Lung cancer at any site can metastasize to distant mediastinum. Radical surgery can be achieved only by extensive dissection of intrapulmonary and ipsilateral mediastinal lymph nodes.

关 键 词：肺癌 淋巴结转移 外科手术 

分 类 号：R734.2[医药卫生—肿瘤]