肺鳞状细胞癌251例淋巴结转移规律分析

目的: 分析肺鳞状细胞癌淋巴结的转移规律,为确定肺癌术中淋巴结清扫方式提供参考依据。方法: 对接受手术治疗的251例肺鳞状细胞癌患者的临床和术后病理资料进行统计学分析。结果: 在清除的2535枚淋巴结(LN)中,434枚(17.1%)发生转移。第1l、10、8、7、6、4、2组淋巴结转移率(LNR)均较高,第9、5、3、1组LNR均较低,差异有统计学意义(P<0.01)。T1期患者LNR较低。中央型肺癌LNR(50.5%)较周围型(27.1%)高(P<0.01)。上叶肺鳞状细胞癌纵隔LNR较下(中)叶高。原发病灶位于上叶者易发生上纵隔组转移;原发病灶位于肺下叶者除下纵隔组外,亦可出现上纵隔组转移。跳跃性纵隔LNR为19.5%。结论: 肺鳞状细胞癌淋巴结转移与肿瘤原发部位有关,且伴跳跃性纵隔淋巴结转移,外科治疗中对原发病灶位于上叶者,应重点清扫上纵隔组LN和下纵隔第7组LN;对下(中)叶者,除下纵隔组LN外,也应清扫上纵隔组LN。

Analysis of lymph node metastasis of lung squamous cell carcinoma in 251 cases

Objective: To investigate the lymph node metastasis of lung squamous cell carcinoma to provide the basis of dissecting lymph node.Methods: The clinical and pathological data of 251 cases with lung squamous cell carcinoma were statistically analyzed.Results: Among the dissecting 2 535 lymph nodes,metastasis occurred in 434 lymph nodes.The metastasis rates of lymph nodes in group 11,10,8,7,6,4 and 2 were high,the metastasis rates of lymph nodes in group 9,5,3 and 1 were low,the difference of which was statistically significant(P<0.01).The metastasis rate of lymph nodes in stage T1 patient was low.the metastasis rate of lymph nodes in patient with central lung cancer(50.5%) was higher than that in patient with peripheral lung cancer(27.1%)(P<0.01).The metastasis rate of lymph nodes of mediastinum in upper lobe lung squamous cell carcinoma was higher than that in lower(middle) lobe.The lymph node metastasis to superior mediastinum of primary lesion in upper lobe was more likely to occur,the lymph node metastasis to superior and inferior mediastinum of primary lesion in lower lobe was more likely to occur.The skip mediastinum metastasis rate was 19.5%.Conclusions: The lymph node metastasis of lung squamous cell carcinoma is closely related to primary lesion,which accompanied skip mediastinum metastasis.The lymph nodes of superior mediastinum and group 7 of inferior mediastinum should be dissected in patients with upper lobe primary lesion,the lymph nodes of superior and inferior mediastinum should be dissected in patients with lower(middle) lobe primary lesion.