非小细胞肺癌肺内淋巴结转移规律的临床研究  

Clinical Pattern of Pulmonary Lymph Node Metastasis in Non-small Cell Lung Cancer

作　　者：崔岳[1] 杨晓军[2] 谢天鹏[2] 向润[2] 李强[2] 

机构地区：[1]昆明医科大学第一附属医院胸外科,昆明650000 [2]四川省肿瘤医院胸外科,成都610041

出　　处：《中国胸心血管外科临床杂志》2016年第10期982-987,共6页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：四川省科技厅应用基础研究计划项目(2014JY0096)~~

摘　　要：目的 探讨非小细胞肺癌肺内淋巴结转移的规律以及检测肺内第12、第13组淋巴结的临床意义。方法 选取2015年1～6月间在四川省肿瘤医院胸外科接受标准肺癌根治手术及系统性淋巴结清扫术的患者38例,其中男29例、女9例,年龄44～73（61.1±15.4）岁;鳞癌20例,腺癌17例,肉瘤样癌1例;所有患者术前未进行放、化疗。对术后标本内的肺内淋巴结进行取材并标记所有淋巴结进行病理检测。结果 共取得淋巴结652枚,平均每例17.2枚。转移淋巴结共78枚,转移度为12.0%。24例出现淋巴结转移,转移率为63.2%。其中N1 22例,N1＋N2 10例,跳跃性N2 2例。38例患者中共检出第12、13组淋巴结转移者12例,转移率为31.6%。共清扫第12、第13组淋巴结95枚,14枚转移,转移率为14.7%。常规病理检测无纵隔及肺内淋巴结转移患者18例中检出单纯第12、第13组淋巴结转移者4例,检出率为22.2%（4/18）,N1淋巴结漏诊率为33.3%（4/12）。单因素和多因素分析提示肺内第12、第13组淋巴结转移率与肿瘤的分化程度有关（χ～2=6.453,P=0.011）,与病理类型（χ～2=0.118,P=0.732）、肿瘤大小（χ～2=0.930,P=0.759）及肿瘤分型（χ～2=1.648,P=0.199）无关。结论 肺内淋巴结在肺癌转移过程中占据相当的比例,对于非小细胞肺癌尤其分化程度较低的患者应常规进行病理检测,以提高肺癌分期的准确率。Objective To elucidate the clinical pattern of pulmonary lymph node metastasis and the significance of station No. 12 and No. 13 lymph nodes biopsy in patients with non-small cell lung cancer （NSCLC）. Methods Thirty- eight NSCLC patients underwent standard radical resection of pulmonary carcinoma and systemic lymphadenectomy between January 2015 and June 2015. There were 29 males and 9 females with a mean age of 61.1±15.4 years （ranged from 44 to 73 years）. There were 20 patients of squamous carcinoma, 17 patients of adenocarcinoma and 1 patient of sarcomatoid carcinoma. All patients didn＇t receive radioor chemotherapy before the operation. All the lymph nodes in the surgical specimens were marked and sampled for pathology examination. Results We obtained 652 lymph nodes in total （17.2 per patient）. Seventy-eight lymph nodes of 24 patients showed lymphatic metastasis with a metastasis degree of 12.0% （78/652） and a metastasis rate of 63.2% （24/38）. Among which there were 22 patients of Nl metastasis, 10 of N1＋N2 and 2 of N2 skipping metastasis. Routine pathological examination of N1 metastasis demonstrated 12 patients of positive station No.12 and No.13 lymph nodes with the metastasis rate of 31.6%. The total amount of dissected lymph nodes was 95, among which there were 14 lymphatic metastasis with the metastasis rate of 14.7%. Four patients with nodal involvement in lymph node stations No.12 or No,13 were identified from 18 patients without mediastinal and intrapulmonary lymph node metastases confirmed by routine pathological examination. The detection rate was 22.2% （4/18） and the rate of N, missed diagnosis was 33.3% （4/12）. Univariate and multivariate analysis suggested that the metastasis degree of pulmonary lymph nodes of station No.12 and No.13 was associated with tumor differentiation grade （x^2=6.453, P=0.011）, while it didn＇t show any significant differences as to pathology subtype （x^2=0.118, P=0.732）, tumor size （x^2=0.930, P=0.759）, or tumor classif

关 键 词：非小细胞肺癌 肺内淋巴结 转移 

分 类 号：R734.2[医药卫生—肿瘤]