肺癌淋巴结廓清程度对手术根治性的评价

Effect of extended lymph nodes dissection on curative resection of lung cancer

作者近９年来，对３８６例肺癌患者施行了手术切除。术中按成毛韶夫肺癌淋巴结分布图对肺门和同侧纵隔淋巴结进行了广泛廓清。共清除淋巴结２６０３组，平均每例清除６．７４组。淋巴结转移率为４９．２％（１９０／３８６）。单纯Ｎ１４３例，占１１．１％；Ｎ２（包括Ｎ１＋Ｎ２）１４７例，占３８．１％。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％。肺癌淋巴结转移具有跳跃性和多发性。作者强调只有广泛清除了肺内和纵隔淋巴结才有可能达到根治，否则应被视为非根治术。

We evaluated the effect of extended lymph nodes dissection on curative resection in 386 patients with lung cancer surgically treated for 9 years. The extended lymph node dissection of the hilar and mediastinum was performed on the basis of mapping system for mediastinal lymph nodes developed by Naruke.Altogether 2603 groups of lymph nodes were dissected (mean 6 74 groups). The overall metastatic rate was 49 2% (190/386), including simple N 1 diseases (43 cases,11 1%) and N 2 diseases (147,38 1%).The metastatic rate for squamous cell carcinoma, adenocarcinoma, small cell carcinoma and large cell carcinoma was 30 1%, 44 1%,48 0% and 50 0%, respectively.The lymphatic metastases in lung cancer showed the features of saltatory infiltration and multiple levels of involvement.Cure could be achieved only after extended dissection of intrapulmonary and mediastinal lymph nodes.