肺癌淋巴结转移特点及转移方式的临床分析

目的探讨原发性肺癌胸内淋巴结转移特点及转移方式,为确定肺癌术中淋巴结廓清范围提供依据。方法按Na-ruke肺癌淋巴结分布图作为淋巴结廓清标志,对118例肺癌行完全性切除及系统性淋巴结廓清术。结果118例肺癌共清除淋巴结835枚。N1占15.6%(63/405枚),N2占17.4%(75/430枚)。跳跃性N2共15例,分布在纵隔第2、4、5、6、7组淋巴结。肺原发肿瘤大小与淋巴结转移之间无明显关系。小细胞肺癌淋巴结转移率最高,腺癌淋巴结转移率亦高于鳞癌。肺癌淋巴结可呈跳跃式纵隔转移,且肺下叶癌较肺上叶癌多见。结论肺癌淋巴结转移具有多组别、多区域及跳跃性特点,系统性胸内淋巴结廓清在肺癌术中应常规应用。

Clinical analysis on characteristics of lymph node metastasis in lung cancer

Objective To investigate the characteristics and patterns of lymph node metastasis in lung cancer and to provide evidence for determining the range of lymph node dissection.Methods One hundred and eighteen patients with lung cancer received complete resection combined with systematic lymph node dissection according to the mapping system developed by Naruke.Results A total of 835 lymph nodes were dissected from 118 lung cancer patients.The positive ratios of N1 and N2 were 15.6% and 17.4% respectively.Fifteen patients were found with skipping N2 which were located in 2,4,5,6 and 7 lymph node groups respectively.There was no significant relationship between the size of primary tumor and lymph node metastasis.Small cell lung cancer showed the highest risk of lymph node metastasis.The metastatic rate of lymph node in adenocarcinoma was markedly higher than that of squamous cell carcinoma.Skipping mediastinal lymphatic metastasis was found more frequently in lower lobar tumors than that in upper lobar ones.Conclusion Lymph node metastasis of lung cancer may occur in multiple groups and regions,even in a skipping pattern.Systematic lymph node dissection may be routinely performed in pulmonary resection for lung cancer.