肺癌经支气管壁浸润的临床病理研究

目的 :从病理学角度探索不同组织类型肺癌向近侧支气管壁侵袭与向纵隔内侵袭的规律。方法 :对 15 1例中心型肺癌手术切除标本近侧支气管与 16 0例N2 肺癌的 35 2组纵隔转移淋巴结进行病理学研究。结果 :癌细胞沿管壁粘膜下层或多层面直接侵袭是肺癌扩延的主要方式 ,96 6 %的癌侵袭发生在距瘤缘 1 5cm以内的管壁上 ,其侵袭距离与病理类型、侵袭方式及TNM分期因子相关。肺癌N2 转移可呈现单组、多组和跳跃式转移 ,其分布最密集的部位依次是第 7、4、3、5组淋巴结 ,N2 转移率与肿瘤大小、组织学类型及分化程度有密切关系。转移淋巴结对支气管壁的侵袭也是癌扩延不容忽视的形式 ,尤以腺癌为突出。结论 :为获得根除性切除 ,支气管切端距瘤缘的安全界限原则上应超过 1 5cm ;并应重视转移淋巴结对支气管壁的侵袭性 ,必须主动、系统清除同侧胸腔肺门及上、下纵隔淋巴结

A clinicopathological study of bronchial invasion of lung cancer

Objective: To investigate the characteristics of proximal bronchial invasion and mediastinal lymph node metastasis of lung cancer of different types.Methods: Proximal bronchus of 151 operatively resected specimens of hilar type lung cancer were selected for cross sectional pathological study,and in 160 N 2 lung cancer,total 352 groups of mediastinal lymph node invaded were analyzed.Results: Evidence showed that the direct invasion of tumour cells through the submucosal layer or multiple layers was the major form of lung cancer spread;96.6% of the cancerous invasion occurred at the proximal bronchial wall less than 1.5 cm apart from the margin of the cancer.The extension of invasion was correlated with the histopathologic type of cancer,mode of invasion and TNM classification.N 2 disease appeared as single group,multi groups and jumping form groups.The highest metastatic site of lymph node was group 7 mediastinal lymph node,the followings were group 4,3 and 5 lymph nodes.The N 2 metastasis was highly correlated with the size,histological classification and cell differentiation of the cancer.Besides,the invasion in the bronchial wall by metastatic lymph nodes was also an important way for the cancer spread,especially in adenocarcinoma.Conclusion: In order to achieve radical removal of tumor,it is imperative to keep a distance of 1.5 cm or more between the excision margin of the bronchus and the tumor,and to dissect the lymph nodes of the hilar and upper and lower mediastinum at the homolateral thoracic cavity extensively and completely.