肺腺癌肺及纵隔淋巴结转移规律与淋巴结广泛廓清术的临床意义

Features of pulmonary and mediastinal lymph node metastasis and clinical significance of extended lymph node dissection in primary lung adenocarcinoma

目的:探讨原发性肺腺癌淋巴结转移的特点和广泛廓清纵隔淋巴结的意义。方法:回顾性分析259例肺腺癌临床资料。全部肺腺癌均按Naruke肺癌淋巴结的分布图施行手术切除,进行广泛肺门、叶间及纵隔淋巴结廓清术。用统计学方法分析肺腺癌T分期与N分期的相关性。结果:清除淋巴结1695组。N1转移率8.9%,N2转移率20.1%,N1+2转移率23.9%,跳跃转移45.6%。T1期的N2转移2例。T2以上转移112例。淋巴结转移与T分期有关,但不存在因果关系。结论:T1期肺腺癌早期淋巴转移,所以有必要广泛廓清肺内、同侧纵隔淋巴结。

Objective：To investigate the features of the lymph nodes metastasis of primary lung adenocarcinoma,and to identify the significance of extended lymph node dissection. Methods：The clinical data of 259 patients undergoing the resection of lung cancer were analyzed retrospectively. Based on the distribution map of mediastinal lymph nodes developed by Naruke,the hilar,interlobular,and mediastinal lymph nodes were resected. The relationship between the T and N stages in lung adenocarcinoma was analyzed statistically. Results：A total of 1695 groups of lymph nodes were resected. The metastatic rates of N1,N2,and N1＋2 lung adenocarcinoma were 8.9%,20.1%,and 23.9%,respectively. Skip metastatic rate was 45.6%. N2 metastasis was found in 2 patients with T1 lung adenocarcinoma and 112 patients with T2,T3,and T4 lung adenocarcinoma. The lymph node metastasis was correlated with T stage,but no causality was found between them. Conclusion：The lymph node metastasis may exist at the early stage of Tl lung adenocarnoma,so extended dissection of intrapulmonary and ipsilateral mediastinal lymph nodes is necessary.