纵隔淋巴结肿大作为非小细胞肺癌N病变标记的意义

报告５６例非小细胞肺癌（ＮＳＣＬＣ）手术摘除的纵隔淋巴结标本的直接观察结果。发生淋巴结肿大（直径≥１．０ｃｍ）假定为Ｎ病变５２例（９２．９％）。其中假定Ｎ１１１例，Ｎ２４１例。经病理学检查确定为Ｎ病变１９例，包括Ｎ１３例，Ｎ２１６例。假定为Ｎ０病变４例，其中１例为真正Ｎ１病变。鳞癌患者普遍为假定的Ｎ２病变，但真正Ｎ病变发生率低（２／１６例，１１．１％），和非鳞癌患者（１４／２５例，５６％）对比，差异有非常显著性（Ｐ＜０．０１）。因此，仅根据纵隔淋巴结大小不能可靠地评估Ｎ病变和术前分期，特别是鳞癌。在发生纵隔淋巴结肿大，但未取得转移病变的组织学依据时，应争取开胸探查手术治疗。

Enlarged Mediastinal Nodes as Markers of Inovlvement by NSCLC

The results of histological observation on mediastinal nodes resected in 56 cases of non-small cell lung cancer were analysed. Enlarged mediastinal nodes with diameter greater than 1. 0cm presented in 52 cases (92.9 % ), including 11 cases of presumed N, disease and 41 cases of presumed N2 diseases. But only 19 true N2 diseases were confirmed by pathological examination, including 3 N1 disease and 16 N2 disease. One true N1 disease was found in 4 presumed N0 disease. Presumed N2disease was given to in all 16 cases of squamous carcinoma, however only 2 were true(11.1 % ). On the other hand 14 true N2 disease (56% ) presented in 25 cases of adenocarcinoma with presumed N2 disease (P<0.01). Hence, it is impossible to assess N disease and stage of lung cancer preoperatively by the size of node, especially in case of squamous carcinoma. Thoractomy is advisable in cases of enlarged mediastinal nodes when the histological evidence of mediastinal involvement is not available.