非小细胞肺癌跳跃性纵隔淋巴结转移及其廓清的临床探讨

目的：探讨非小细胞肺癌（NSCLC）跳跃性纵隔淋巴结转移（跳跃性N2）的特点及转移方式，为制定合理的纵隔淋巴结廓清范围提供依据。方法：回顾性总结121例（广州军区总医院1996－1999年101例和北京大学深圳医院1999－2000年20例）经系统性淋巴结廓清后病理证实为N2的NSCLC患者的临床资料，将跳跃性N2与非跳跃性N2的数据进行比较。结果：发现跳跃性N2 23例（19．0％，其中腺癌18例（78．3％）。跳跃性N2患者中平均每例纵隔淋巴结转移组为1．1组，明显低于非跳跃性N2的3．1组。肺上叶肿瘤跳跃性N2多位于第4或第5组淋巴结，肺下叶肿瘤跳跃性N2多位于第7和第8组淋巴结。结论：跳跃性N2是NSCLC纵隔淋巴结转移的一个独特亚群。在行肺上叶癌根治术时，应常规清扫第4和第5组淋巴结；在行肺下叶癌根治术时，应常规清扫第7和第8组淋巴结。

Skipping metastasis of mediastinal lymph nodes in non- small cell lung cancer: A clinical discussion on metastatic mode and according dissection

Objective To discuss the clinical characteristics of skipping metastasis of mediastinal lymph node(N 2) and metastatic mode in patients with non small cell lung cancer(NSCLC) so as to provide reasonable range of mediastinal lymph nodes dissection. Methods Between 1996 and 2000, 121 patients with NSCLC with N 2 disease underwent operative resection with systemic mediastinal lymph nodes dissection . The data and several variables were compared between skipping N 2 patients and non skipping N 2 patients. Results Twenty three patients with skipping N 2(19.0%) were found. Adenocarcinoma was predominant histologic type(78.3%). Every patient with skipping N 2 involved 1.1 mediastinal lymph nodes groups , while non skipping N 2 involved 3.1 groups. Tumor located in upper lobes usually skipped to level 4 or level 5 lymph nodes, while tumor located in lower lobes usually skipped to level 7 or level 8. Conclusions Patients of NSCLC with skipping N 2 represent a unique subgroup of N 2 disease. According to the metastatic mode of skipping N 2 in patients with NSCLC, level 4 or level 5 lymph nodes should be dissected in upper lung cancer dissection. Level 7 or level 8 lymph nodes should be dissected in lower lung cancer dissection.