肺癌手术淋巴结清扫范围的探讨

目的 通过总结肺癌的淋巴结转移规律，探讨肺癌手术胸腔淋巴结清扫的范围。方法 对1987年1月～2002年12月740例肺癌根治性肺叶或一侧肺切除术患者进行回顾性分析。本组手术按Naruke肺淋巴结分布图对纵隔和肺门淋巴结进行了广泛清扫，共清除胸腔淋巴结3492组。切除的病肺和淋巴结行病理切片检查，其中鳞癌416例，腺癌255例，大细胞肺癌22例，小细胞肺癌30例，其他类型17例。根据病理结果，对肿瘤部位、分型、大小、细胞分化程度等因素与淋巴结转移的关系进行分析。结果 740例中362例（48．9％）存在N1或（和）N2淋巴结转移，其中N2淋巴结转移共276例（37．3％）。本组手术清除纵隔淋巴结2401组，其中转移淋巴结（N2）524组，纵隔淋巴结转移度21.8％。相关分析结果表明，肺癌淋巴结转移与肿瘤部位、细胞类型、肿瘤T分级和细胞分化程度密切相关。结论 肺癌易发生淋巴结转移，且与多种因素有关，为达到根治目的，应提倡纵隔和肺门淋巴结系统清扫。

Extent of lymphnode dissection in the resection of lung cancer

Objective To discuss the necessity of mediastinal lymph node dissection in the resection of lung cancer. Method 740 patients with lung cancer underwent lobectomy or pneumonectomy during Jan. 1987 to Dec. 2002 in our hospital were retrospectively aralyzed. Totally 3492 lymph nodes were removed and checked up pathologically. Result Lymph nodes with metastasic were confirmed in 362 out of the 740 cases, and the metastasis ratio was 48. 9%, and among them in 276 patients suffered N2 lesion, with the ratio of 37. 3%. The statistic result showed that lymph node metastasis was correlated to the location, cell type, the size, T stage and differentiation of lung cancer. Conclusion Lymph node metastasis in lung cancer is common and related to multiple factors. In order to obtain radical cure, both mediastinal and hilar lymph nodes should be removed.