434例肺癌淋巴结转移及其廓清的临床研究

Clinical Study of Lymph Nodes Metastasis and Dissection of 434 Cases of Lung Cancer

目的研究肺癌淋巴结转移的方式与规律,以探讨肺癌淋巴结合理的手术廓清范围。方法对434例肺癌患者施行手术并予淋巴结廓清,回顾性分析病理证实的转移淋巴结的分布情况。结果 手术共清除 2 198组淋巴结,病理证实有癌细胞转移的749组。淋巴结转移率T1期为16.5％,T2期33.5％,T3期35.6％,T4期52.3％,T1期和T4期的组间有显著性差异（P<0.01）。上叶肺癌上纵膈与下纵膈淋巴结转移有显著差异。左上叶肺癌第5组淋巴结有30.6％转移,左下叶和右中、下叶肺癌第7组淋巴结有26.5％转移。结论 除T1期肺癌淋巴结转移仅限于区域性上纵膈或下纵膈外,总体上,上叶肺癌以上纵膈淋巴结转移居多,而中、下叶肺癌则上、下纵膈均可发生淋巴结转移。左上叶肺癌第5组淋巴结转移和中、下叶肺癌第7组淋巴结转移是上、下纵膈之间淋巴结扩大转移的信号。原发肺癌除了T1期可仅行区域性上纵膈或下纵膈淋巴结清扫外,均应行系统性肺门和上下纵膈淋巴结廓清。

To study the lymph nodes metastasis of lung cancer and to find reso-nable dissection of lymph nodes Methods In 434 surgical patients with lung cancer, the pathologically confirmed dissected lymph nodes were retrospectively analyzed. Results Among 2 198 groups of lymph nodes systemically dissected, 749 groups were pathologically metastative. The rate of lymph nodes metastasis for T1 was 16. 5% ,T2 33. 5% , T3 35. 6%, T4 52. 3% ;T1 and T4 had significantly lower and higher metastasis rates respectively. The metastasis rate of lymph nodes in the upper mediastinum of upper lobe cancer was significantly higher than that in the lower mediastinum. Aortic lymph node metastasis was found in left upper lobe cancer in 37 out of 121 patients, while subcarinal lymph node metastasis was in both lower lobe and right middle lobe cancers in 48 out of 181 patients. Conclusion Lymph node metastasis is limited to regional upper or lower mediastinal area in T1 lung cancer, while both upper and lower mediastinum are metastasis sites for both lower lobe cancers. Aortic and subcarinal lymph node metastases are the signals for diffusion of lymph node metastasis between upper and lower mediastinum. Systemic dissection of lymph nodes should be done in all lung cancers except that regional mediastinal dissection is enough in T1 lung cancer.