肺癌淋巴结转移特点的研究

Study of the characteristics of lymph node metastasis in lung cancer

目的 探讨肺癌淋巴结转移频度、分布及特点 ,为淋巴结清除术提供依据。方法 按Naruke肺癌淋巴结分布图对 348例肺癌病人施行根治性手术及系统性淋巴结清除 ,分析其淋巴结转移特点。结果 36 89组淋巴结N1转移率 2 34% ,N2 转移率 16 5 %。Tis期肺癌无淋巴结转移 ;T1期以后各期肺癌N1、N2 均可见转移 ;T1期、T2 期鳞癌和腺癌N2 转移率相比差异有显著性 ;淋巴结转移频度与T分期直线相关。肺下叶癌较肺上叶癌更容易转移至纵隔。肺上叶癌较肺下叶癌更容易发生跳跃式纵隔转移。结论 淋巴结转移腺癌比鳞癌活跃 ,小细胞肺癌最活跃 ,且随着T分期增加而增加 ;肺癌可跨区域纵隔转移 ;除T1期鳞癌不进行系统性淋巴结清除亦有可能达到根治目的外 ,其余类型肺癌均应进行系统性淋巴结清除。

Objective: To investigate the frequency , distribution and features of lymph node metastasis in lung cancer, and to provide evidence for lymph node dissection. Methods: 348 patients with lung cancer were retrospectively studied, all patients received R_3 surgery plus systemic lymph node dissection according to the mapping system developed by Naruke. Results: Total 3 689 groups of lymph nodes were dissected . The metastatic rates of N_1 and N_2 were 23.4% and 16.5%, respectively. N_1 or N_2 metastasis was not found in Tis tumor. There was a significant difference of N_2 metastasis rates between squamous cell carcinoma and adenocarcinoma in T_1 or T_2 tumor (P<0.01). There was close correlation between lymph node metastasis and T stage (r=0.9855). Salutatory metastasis accounted for 41.5% of N_2 metastasis. Lung cancers in lower lobes were more likely to spread to the mediastinum (P<0.05). Lung cancers in upper lobes are more likely to spread to the lower mediastinum. Conclusion: Patients with small cell carcinoma of the lung have highest risk of develop lymph node metastasis than that in adenocarcima and squamous cell carcinoma. Except T_1 squamous cell carcinoma are likely to be cured without lymph node dissection, the other stages of lung cancer ought to underwent systemic lymph node dissection.