Ⅲ期肺癌淋巴转移的病理学特点和广泛清扫的意义

目的:为了了解Ⅱ期肺癌的淋巴结转移的病理学特点和探讨如何处理.方法:本文将124例Ⅱ期肺癌的淋巴结转移作一分析.结果:淋巴转移与原发肿瘤的病理类型,分化程度有关;与原发肿瘤的大小无正比关系;大于1cm淋巴结只能给CT、MR1造成误诊,而病理检查并非一定呈阳性,小病灶大转移并非罕见,跳跃式转移及纵隔内交叉转移较多见;T_(3-4)有外侵时淋巴转移十分活跃.结论:正确的临床分期必须依靠术后淋巴的病理检查,隆突下淋巴结是上下左右纵隔淋巴汇集处、向对侧纵隔转移的前哨站,淋巴清扫本身是解除症状的治疗措施,对减轻症状,提高生活质量,暂时延长生命都具积极意义.最佳的纵隔淋巴清扫应采用胸骨正中切口.

Characterisitic feature of lymph metastases and significance of clearing lymph nodes in stage ?? lung cancer

purpose: In order to evaluate the feature of lymph node metastases in stage? lung cancer, we retrospectively re-viewed 124 patients with stage ? cancer. Methods: 124 patients with stage ? lung cancer were retrospectively reviewed by analysing the resected lymph node in operations for finding metastases. Results:The lymph node metastases relates to primary tu-mor, cell differentiation, and pathologic type other than tumor size. Lymph nodes less than 1 cm may make wrong diagnosis on the films of CT and MRI, but pathological findings may be positive. It is not rare that small size tumors with extensive and big area of metastases and crossed metastases in either right or left mediastium. Jumping lymph metastases cam be found in hilae or mediastium. T3 and T4 tumors have the characteristics of multiple lymph groups involved. Conclusions: Correct clinic stages for lung cancers depend on the pathological findings of lymph nodes after operations. The carina nodes are the collection points of lymph drainage from mideastium. They are the front stations before crossed metastases happen. It is very important to resect lymph nodes in mediastium thoroughly, espcially carina nodes. Clearing lymph nodes is itself treatment method which can relieve symptoms, improve quality of life and extend life expectancy. The best approach is the middle sternal thoracotomy.