周围型非小细胞肺癌肺内第13、14组淋巴结转移规律研究

Metastatic pattern of No.13 and No.14 intrapulmonary lymph nodes in patients with peripheral non-small cell lung cancer

目的探讨周围型非小细胞肺癌(NSCLC)肺内淋巴结转移的规律以及检测肺内第13、14组淋巴结的临床意义。方法回顾性分析2013~2015年于重庆医科大学附属第一医院接受系统性胸内淋巴结及肺内淋巴结清扫术的234例原发性周围型NSCLC患者的临床资料,其中男159例、女75例,年龄36~89(61.35±8.57)岁。对术后N1期淋巴结标本肺门(第10组)、叶间(第11组)、肺叶(第12组)及肺段(第13、14组)分站分别进行统计分析。结果234例患者共清扫第10~14组淋巴结3019枚,平均每例患者12.9枚。其中263枚淋巴结阳性,淋巴结阳性率为8.71%(263/3019)。99例患者出现淋巴结转移,转移率为42.31%(99/234),其中N1期淋巴结转移40例,N1+N2期淋巴结转移48例,跳跃性N2期淋巴结转移11例。234例患者中共检出第13、14组淋巴结转移者16例,转移率为6.84%(16/234)。共清扫第13、14组淋巴结886枚,86枚转移,转移率为9.71%(86/886)。术前胸部CT扫描肺门及纵隔淋巴结肿大者中,术后病理报告阳性者占56.32%;CT扫描淋巴结阴性者中,术后病理报告阳性者占34.01%。结论临床上检测NSCLC第13组、14组淋巴结与非肿瘤所在叶支气管旁淋巴结的转移情况十分必要,有利于获取术后准确的TNM分期,对于指导术后治疗意义重大。术前胸部CT的结果不能作为淋巴结清扫的依据。

Objective To explore the clinical pattern of intrapulmonary lymph node metastasis and the significance of No.13 and No.14 lymph nodes biopsy in patients with non-small cell lung cancer(NSCLC).Methods The clinical data of 234 patients with primary peripheral NSCLC who underwent systemic dissection of intrathoracic lymph nodes and intrapulmonary lymph nodes in the First Affiliated Hospital of Chongqing Medical University between 2013 and 2015 were retrospectively analyzed.There were 159 males and 75 females,aged 36-89(61.35±8.57)years.Statistical analysis was performed accordingly on hilar(No.10),interlobar(No.11),lobar(No.12)and segmental(No.13 and 14)sites of the samples of N1 lymph nodes after surgery.Results A total of 3019 lymph nodes of No.10-14 were dissected in 234 patients(12.9 per patient).The 263 lymph nodes were positive with a rate of 8.71%(263/3019)and lymph node metastasisa occured in 99 patients with a rate of 42.31%(99/234),among whom there were 40 patients of N1 metastasis,48 of N1+N2 metastasis and 11 of N2 skipping metastasis.Routine pathological examination demonstrated No.13 and No.14 lymph nodes metastasis in 16 patients with a rate of 6.84%(16/234).In 886 dissected lymph nodes of No.13 and No.14,86 lymph nodes showed metastasis with a rate of 9.71%(86/886).Of the patients with swelling hilar and mediastinal lymph nodes reported by preoperative CT scan,only 56.32%of them were confirmed with lymph node metastasis by postoperative histopathology;while 34.01%of the patients with normal size lymph nodes had lymph node metastasis.Conclusion In the surgical treatment of NSCLC,it is necessary to detect the metastasis of No.13 and 14 lymph nodes and non-tumor parabronchial lymph nodes,which is helpful to obtain accurate postoperative TNM staging and is of great significance for guiding postoperative treatment.Preoperative CT is not a reliable method to judge lymph node metastasis,particularly for intrapulmonary lymph node metastasis.