215例肺癌的胸内淋巴结转移规律及临床分析

Clinical Analysis of Thoracic Lymph Node Metastasis in Patients with Lung Cancer

目的:分析肺癌的胸内淋巴结转移的方式和规律,以探讨可切除性肺癌胸内淋巴结合理的手术清扫范围。方法:收集我院从2004年9月至2006年12月的215例肺癌病例,行根治性切除及系统性胸内淋巴结清扫术,分别记录淋巴结的数量及进行病理检查。分析其胸内各组淋巴结转移频度,原发部位与淋巴结转移的关系,肿瘤的大小,病理类型与淋巴结转移的关系的特点和规律。结果:215例肺癌患者共清扫胸内1070组的3680个淋巴结,平均每例切除淋巴结17.1个。经病理检查证实其中198个组的468个淋巴结存在转移癌,215例肺癌患者中94例有胸内淋巴结转移,转移率为43.7%。围绕肺门或肺根部的11、10、7、5、4组淋巴结的转移频度比远离肺根部的9、6、8、3、2、1肺上叶癌更易向上纵隔淋巴结转移,而肺下叶(包括中叶)可向上、下纵隔淋巴结转移。组淋巴结高。小细胞肺癌的淋巴结转移率明显高于非小细胞肺癌(P<0.05)。淋巴结转移率随肿瘤增大而增加。结论:多数肺癌的淋巴结转移遵循由近及远、自上而下、由肺内经肺门再向纵隔的顺序转移规律,纵隔淋巴结的转移呈"跳跃式"较为常见。肺切除术时施行系统性胸内淋巴结清扫是必要的。

Objective： To analyze the modality and pattern of thoracic lymph node metastasis from lung cancer and to explore the reasonable surgical dissection extension of intrathoracic lymph nodes for patients with lung cancer. Methods： From September 2004 to December 2006, 215 lung cancer patients were enrolled into this study. All these patients received radical resection of primary tumor and systemic intrathoracic lymph node dissection. The number of lymph nodes in each area was recorded and pathological examination was performed. The frequency of lymph node metastasis in each area, the relationship of primary tumor site, tumor size and histology with lymph node metastasis were analyzed. Results： A total of 3.680 lymph nodes were found in 1.070 areas. The average number of Lymph node dissected was 17.1 for each case. A total of 468 positive lymph nodes were found in 198 lymph node groups. Intrathoracic lymph node metastases were found in 94/215 patients, with a positive rate of 43.7%. The frequencies of metastasis to the area 11,10, 7, 5 and 4 which surrounded the hilar were much higher than those to the area of 9, 6, 8, 3, 2, and 1 which were far away from the hilar. The incidence of lymph node metastasis was higher in small cell lung cancer than in non-small cell lung cancer （P〈0.05）. The rate of lymph node metastasis was increased with the enlargement of tumor size. Tumors tocated in the upper lobe had a tendency of metastasis to the upper mediastinum more frequently, while tumors located in the lower lobe had a tendency of metastasis to the upper and lower mediastinum. Conclusion： Most of metastatic lymph nodes in lung cancer follow the lymphatic drainage, that is, from intrapulmonary to the hilar and then to the mediastinum. The skip metastasis of mediastinum nodes is common. Systemic dissection of intrathoracic lymph nodes is necessary in radical surgery for lung cancer.