肺癌纵隔淋巴结合理廓清范围的临床探讨

目的：探讨非小细胞肺癌(NSCLC)纵隔淋巴结转移方式。方法：回顾性研究1989年1月—1999年1月，淋巴结廓清术后病理证实的纵隔淋巴结转移(pN2)137例。分析临床病理因素与pN2的关系．应用Logistic回归分析判定纵隔淋巴结CT扫描阴性时(cN0-1)pN2有意义的预测指标；总结不同位置肺癌纵隔淋巴结转移的方式。结果：NSCLC无论病理类型和临床状态如何，均有纵隔淋巴结转移发生。纵隔淋巴结增大(cN2)和cT2或cT3腺癌患者转移的发生率较高(65．0％，75．0％)。纵隔淋巴结转移多为区域性(80．9％)，跨区域纵隔淋巴结转移多数伴有隆凸下淋巴结受累。结论：对NSCLC应行纵隔淋巴结廓清，尤其对cN2和cT3、cT3腺癌。多数患者单独廓清区域纵隔淋巴结即可达到目的。建议手术中对肺门和隆凸下淋巴结冰冻病理检查，无转移时可不必廓清非区域纵隔淋巴结。

Clinical Study on Reasonable Extent of Mediastinal Lymph Nodes Dissection in Non-Small Cell Lung Cancer

Objective:To elucidate the metastatic mode of mediastinal lymph node and de-termine the reasonable extent of mediastinal lymph nodes dissection in NSCLC.Methods:A ret-rospective study was carried out.One hundred and thirty -seven of patients with N 2 disease NSCLC who underwent surgical resection with systemic mediastinal nodal dissection were studied.Clinical predictors were identified by means of logistic regression analysis and the sites of metas-tasis were analysized.Results:Mediastinal lymph node metastasis could occur in patients with each of cTN status,however,it had a higher incidence in the patients with cN2disease.Adeno-carcinoma histology with T2orT3tumors was the important predictors of N 2 disease in patients with cN0-1disease on the basis of multivariate analysis.The site of N 2 was associated with the location of primary tumor.Metastasis occurred in regional mediastinal lymph node in most patients(80.9%).Subcarinal lymph node appeared to always was involved before non-regional mediastinal metastasis could occurred.Conclusion:Systemic mediastinal nodal dissection should be per-formed in the patients with NSCLC,especially in the patients with c-N2disease and adenocarci-noma histology with T2orT3tumors.If there were no hilar and subcarinal lymph node metastasis,the extent of mediastinal lymph nodal dissection might be limited to the regional mediastinal lymph nodes.