非小细胞肺癌上纵隔淋巴结转移临床分析

摘要

Objective:To analyze of mediastinal lymph nodes metastasis of non-small cell lung cancer,and then discusse the reasonable surgical lymph node dissection.Method:The clinical data of 505 patients with non-small cell lung cancer who underwent lung resection and systematic lymph node dissection in Weifang People's Hospital from September 2010 to May 2015 were analyzed.There were 317 males and 188 females with an average age of 59.1 years old (39-77).There were 108 patients with left upper lobe tumor,86 patients with left lower lobe tumor,170 patients with right upper lobe tumor,27 patients with right middle lobe tumor and 114 patients with right lower lobe tumor.Subcarinal lymph node metastasis was observed in 118 patients(19.4%).There were 202 patients with squamous carcinoma,239 patients with adenocarcinoma and 64 patients with other types of carcinoma.The relationship of mediastinal lymph node metastasis with tumor location,patho-logical types and clinicopathological characteristics were analyzed.Result:There was statistical difference in mediastinal lymph node metastasis rate among different tumor locations(P=0.000).For patients with different pathological types,mediastina lymph node metastasis rate was the highest[56.5%(66/118)]in patients with adenocarcinoma.Mediastina lymph node metastasis rate increased with the increase in T staging,and patients with upper lobe tumor had a significantly higher mediastina lymph node metastasis rate than patients with tumors located in the middle or lower lobe of the left or right lung.Conclusion:Mediastina lymph node metastasis rate are lower in patients with left or right middle or lower lobe tumor,patients with squamous carcinoma whose clinical T staging is within T1.We can be appropriate to relax the surgery.%目的:分析非小细胞肺癌上纵隔淋巴结转移规律,进而探讨合理的淋巴结清扫手术方式.方法:分析2010年9月-2015年5月潍坊市人民医院收治的505例非小细胞肺癌(non-small cell lung cancer,NSCLC)患者行肺手术并纵隔淋巴结系统清扫术的临床资料,男317例,女188例;年龄39~77岁,平均年龄59.1岁.左肺上叶108例、左肺下叶86例、右肺上叶170例、右肺中叶27例和右肺下叶114例;病理类型:鳞癌202例,腺癌239例,其他64例.上纵隔淋巴结转移阳性92例(18.2%).结果:不同肿瘤部位发生上纵隔淋巴结转移情况比较,差异有统计学意义(P=0.000);腺癌发生上纵隔淋巴结转移率[56.5%(52/92)]最高.随T分期进展,上纵隔淋巴结转移的可能性加大,上叶癌上纵隔淋巴结转移率大于肺中下叶癌者.结论:肺中下叶、T1期鳞癌患者,上纵隔淋巴结转移的可能性小,可适当放宽手术方式.