肺癌手术淋巴结根治性清扫范围的探讨

摘要

目的 探讨肺癌手术根治性淋巴结清扫的范围.方法 370例肺癌根治性肺叶或一侧全肺切除术患者的手术结果进行回顾性分析.手术按标准肺癌淋巴结分布规律对纵隔和肺门淋巴结进行了根治清扫,共清除纵隔和肺门淋巴结1746枚.手术切除的肺叶和淋巴结行病理切片检查,其中鳞癌211例,腺癌123例,大细胞肺癌11例,小细胞肺癌16例,其他类型9例.根据病理标本结果,对肿瘤部位、分型、大小、细胞分化程度等因素与淋巴结转移的关系进行分析研究.结果 370例中181例(48.9%)存在N1或N2以及Nl和N2共同淋巴结转移.其中N2淋巴结转移共138例(37.3%).手术清除纵隔淋巴结1200枚,其中转移淋巴结(N2)262枚,纵隔淋巴结转移度21.8%.结论 肺癌发生淋巴结转移机会很大,且与多种因素有关,如肺癌淋巴结转移与肺癌部位、细胞类型、肿瘤T分级和细胞分化程度都有密切关系.手术要达到根治目的,应进行纵隔和肺门淋巴结根治性清扫.%Objective To discuss the necessity of mediastinal lymph node dissection in the resection of lung cancer.Methods 370 patients with lung cancer underwent lobectomy or pneumonectomy were retrospectively analyzed.1746lymph nodes were removed and checked up pathologically. Results Lymph nodes with metastasic were confirmed in 181out of the 370 cases, and the metastasis ratio was 48.9％, and among them in 138 patients suffered N2 lesion, with the ratio of 37. 3％. The statistic result showed that lymph node metastasis was correlated to the location, cell type, the size, T stag e and differentiation of lung cancer. Conclusion Lymph node metastasis in lung cancer is common and related to multiple factors.