肺癌纵隔淋巴结转移及广泛廓清的价值

Metastases to the mediastinal lymph nodes in lung cancer and their extensive dissection

目的研究肺癌纵隔淋巴结转移（Ｎ２）频度、分布范围及特点，为广泛廓清提供依据。方法总结９年间手术切除３８６例肺癌患者的临床资料。术中按Ｎａｒｕｋｅ肺癌淋巴结分布图对肺门、同侧纵隔淋巴结进行广泛廓清。结果Ｎ２１４７例，占３８．１％，清除转移Ｎ２２８９组。Ｎ２转移率在鳞癌、腺癌、小细胞癌及大细胞癌分别为３０．１％、４４．１％、４８．０％及５０．０％。肺上叶Ｎ２７１例，清除转移Ｎ２１４６组。上纵隔转移１２４组，占８４．９％；下纵隔转移２２组，占１５．１％。肺下叶（包括中叶）Ｎ２７６例，清除转移Ｎ２１４３组。下纵隔转移６７组，占４６．９％；上纵隔转移７６组，占５３．１％。跳跃式转移７９例，占Ｎ２转移的５３．７％。跳跃式纵隔转移１６例，占１０．９％。结论肺癌纵隔淋巴结转移具有跳跃性、多发性。只有广泛清除了上下纵隔淋巴结，才有可能达到根治。

Objective To study the metastatic frequency, distribution and feature of mediastinal nodes in lung cancer and to establish criteria for nodal dissection. Methods Clinical data of 386 patients who underwent resection of lung cancers in the past 9 years were analyzed retrospectively. Based on the distribution map of mediastinal lymph nodes developed by Naruke, ipsilateral hilar and mediastinal nodes were resected. Results 147 cases (38.1%) had mediastinal nodal involvement (N 2). A total of 289 groups of nodes were dissected. The rate of N 2 disease among squamous cell, adeno , small cell and large cell carcinomas was 30.1%, 44.1%, 48.0% and 50.0%, respectively. In 71 cases with N 2 disease in the upper lobes, 146 groups of N 2 nodes were resected, including 124 groups in the upper mediastinum (84.9%) and 22 groups in the lower mediastinum (15.1%). In 76 cases with N 2 nodes in the lower and middle lobes, 143 groups of N 2 nodes were dissected, including 76 groups in the upper mediastinum (53.1%) and 67 groups in the lower mediastinum (46.9%). Saltatory metastases occurred in 79 patients, accounting for 53.7% of N 2 nodes and in 16 cases that occurred in the mediastinum (10.9%). Conclusion The feature of mediastinal lymph node metastases in lung cancer may be saltatory and multiple. Cure can be achieved only after extensive dissection of the upper and lower mediastinal nodes.