T_1、T_2肺鳞癌及腺癌淋巴结转移特点及其临床意义

T_1,T_2 squamous or adenocarcinoma of the lung:characteristics of lymph node metastasis and its clinical significance

目的 研究T1、T2 肺鳞及腺癌淋巴结转移频度、分布范围及特点 ,为广泛清扫提供依据。 方法 按Naruke肺癌淋巴结分布图对 2 5 4例T1、T2 肺鳞癌及腺癌施行了手术切除及广泛肺内、叶间及纵隔淋巴结清扫术并对其进行统计分析。 结果 清除淋巴结 16 85组。N1淋巴结转移率 2 0 0 % ,N2 淋巴结转移率为 10 2 %。T1、T2 间淋巴结转移率差异有非常显著性意义 (P <0 0 1)。T1鳞癌无N2 转移 ,N2 转移在鳞癌、腺癌分别为 2 2 0 %和 40 9% ,差异有非常显著性意义 (P <0 0 1)。6 4 3%的鳞癌为某 1组N2 转移 ,腺癌≥ 3组转移占 46 2 % ,跳跃式转移占N2 转移的 5 7 5 %。N2 阳性上叶肺癌下纵隔转移占 13 6 % ,N2 阳性的下叶肺癌上纵隔转移占 5 1 6 %。 结论 随着瘤体增大 ,淋巴结转移频度增加 ,腺癌比鳞癌淋巴结转移更加活跃 ,任何部位的肺癌都可跨区域纵隔转移。除T1鳞癌外 ,只有广泛清扫同侧肺内及纵隔淋巴结才能达到根治。

To investigate the frequency, distribution and features of lymph nodes metastasis in T 1/T 2 squamous carcinoma and adenocarcinoma of lung, and to provide evidence for extensive dissection of lymph nodes. Methods 254 patients with T 1/T 2 squamous carcinoma and adenocarcinoma of lung underwent R2 surgery plus extensive dissection of hilar, interlobular and mediastinal lymph nodes according to the grouping system proposed by Naruke. Results A total of 1?685 groups of lymph nodes were dissected. The metastatic rates of N 1 and N 2 were 20 0% and 10 2%. The difference was very significant between T 1 and T 2 ( P <0 01). No, N 2 metastasis was found in T 1 squamous carcinoma. N 2 metastatic rates were 22 0% in squamous carcinoma and 40 9% in adenocarcinoma ( P <0 01). 64 3% of squamous carcinomas spread to only one group of N 2 nodes, and over 3 groups of lymph nodes were positive in 46 2% of adenocarcinomas. Saltatory metastasis accounted for 57 5% of N 2 metastasis. 13 6% of N 2 positive tumors in the upper lobes metastasized to the lower mediastinum, whereas 51 6% of N 2 positive tumors in the lower lobes spread to the upper mediastinum. ConclusionsThe frequency of lymph node metastasis increases with the growth of tumors. Metastasis occurs more frequently in adenocarcinoma than in squamous carcinoma. Tumor at any site can metastasize to the distant mediastinum. Except for T 1 squamous carcinoma, radical surgery can be achieved only by extensive dissection of ipsilateral intrapulmonary and mediastinal lymph nodes.