摘要
目的 探讨T1肺癌淋巴结转移频度、分布范围及特点 ,为淋巴结清除术提供依据。方法 按Naruke肺癌淋巴结分布图对 2 15例T1肺癌施行了手术及广泛肺内、叶间、纵隔淋巴结清除术并对其进行统计分析。结果 清除淋巴结 16 74组。N1转移率 11% ,N2 转移率 6 %。肿瘤最大直径≤ 1.5cm 和 1.6~ 3.0cm者的淋巴结转移率分别为 5 %和 8%。肿瘤最大直径≤ 1.5cm的鳞癌N1、N2均无转移。N2 转移在鳞癌、腺癌、小细胞癌分别为 5 %、2 3%和 3/ 9,差异有极显著性 (P <0 .0 1)。N2转移鳞癌为某一组淋巴结转移的为 3/ 4 ,腺癌≥ 3组转移占 4 0 % ,跳跃式转移占N2 转移的 4 1%。N2阳性上叶肺癌下纵隔转移占 14 % ,N2 阳性下叶肺癌上纵隔转移占 6 0 %。结论 瘤体增大 ,淋巴结转移频度增加 ,腺癌比鳞癌转移活跃 ,小细胞癌最活跃 ,肺癌可跨区域纵隔转移。除肿瘤最大直径≤ 1.5cm的鳞癌不进行淋巴结清除亦有可能达到根治外 ,其余类型T1肺癌均应广泛清除肺内及纵隔淋巴结。
Objective To investigate the frequency, distribution and features of lymph node metastasis in T 1 carcinoma of the lung, and to provide evidence for lymph node dissection Methods Two hundred and fifteen patients with T 1 carcinoma of the lung underwent R2 surgery plus extented dissection of hilar, interlobular and mediastinal lymph nodes according to the mapping system developed by Naruke Results 1 674 groups of lymph nodes were dissected. The metastatic rates of N 1 and N 2 were 11% and 6% respectively. Lymph node metastatic rates in carcinoma of the lung with maximum diameters less than 1.5 cm and between 1.6 cm~3.0 cm were 5% and 8% respectively. N 1 and N 2 metastasis was not found in squamous cell carcinoma of the lung with a maximum diameter less than 1.5 cm. N 2 metastatic rates were 5% in squamous cell carcinoma?23% in adenocarcinoma and 3/9 in small cell carcinoma, the difference being significant ( P <0.01 ). 3/4 squamous cell carcinoma invaded only one group of N 2 nodes, but over 3 groups of lymph nodes were positive in 40% of adenocarcinoma. Saltatory metastasis accounted for 41% of N 2 metastasis. Fourteen percent of N 2 positive tumors in upper lobes metastasized to the lower mediastinum, whereas 60% of N 2 positive cancers in lower lobes invaded the upper mediastinum Conclusions The frequency of lymph node metastasis increases with the growth of tumors. Metastasis in adenocarcinoma occurs more frequently than in squamous cell carcinoma, but most common in small cell carcinoma. Tumors at any site can metastasize to the distant mediastinum. Except for squamous cell carcinoma with maximum diameter less than 1.5 cm which are likely to be cured without lymph node dissection, other types of T 1 carcinoma of the lung need extended lymph node dissection.
出处
《中华结核和呼吸杂志》
CAS
CSCD
北大核心
2002年第9期524-526,共3页
Chinese Journal of Tuberculosis and Respiratory Diseases
关键词
肺肿瘤
淋巴结转移
淋巴结切除
Lung neoplasms
Lymphatic metastasis
Lymphadenectomy