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目的 探讨原发性肺癌淋巴结转移频度、分布范围及特点 ,为广泛廓清提供依据。方法 按Naruke肺癌淋巴结分布图对 386例肺癌病人施行了手术切除及广泛肺门、叶间及纵隔淋巴结廓清术。结果 清除淋巴结 2 6 0 3组。N1淋巴结转移率 2 0 .1% ,N2 淋巴结转移率 16 .2 %。T1、T2 、T3 间淋巴结转移率差异非常显著 (P <0 .0 1)。T1鳞癌无N2 转移。N2 转移率在鳞癌、腺癌、小细胞癌及大细胞癌分别为 30 .1%、44 .1%、48.0 %及 5 0 .0 %。 6 4.2 %鳞癌N2 转移为某一组淋巴结 ,腺癌有 3组以上转移者占46 2 %。跳跃式转移占N2 转移的 5 3.7%。N2 阳性上叶肺癌下纵隔转移占 15 .1% ,下叶肺癌上纵隔转移占 5 3.1%。结论 肺癌淋巴结转移具有跳跃性、多发性。瘤体增大及外侵淋巴结转移频度增加 ,腺癌比鳞癌转移频度高。任何部位的肺癌均可跨区域纵隔转移。除T1鳞癌外 ,只有广泛清除肺内、同侧纵隔淋巴结才能达到根治目的
Objective To explore the frequency, distribution and characteristics of lymph node metastasis in primary lung cancer, and to provide a basis for extensive dissection. METHODS: 386 lung cancer patients underwent surgical resection and extensive hilar, interlobular, and mediastinal lymphadenectomy according to the Naruke lung cancer lymph node map. Results Lymph node clearance was 620 groups. N1 lymph node metastasis rate was 0.2%, and N2 lymph node metastasis rate was 16.2%. The lymph node metastasis rate was significantly different between T1, T2, and T3 (P < 0.01). T1 squamous cell carcinoma has no N2 metastasis. The N2 metastasis rate was 30.1%, 44.1%, 48.0%, and 50% in squamous cell carcinoma, adenocarcinoma, small cell carcinoma, and large cell carcinoma, respectively. 6 4.2% of squamous cell carcinoma N2 metastases to a certain group of lymph nodes, and adenocarcinomas accounted for 46. 2% of patients with more than 3 groups of metastases. Jumping transfer accounted for 5 3.7% of the N2 shift. In the N2 positive upper lobe, the lower mediastinum metastasis accounted for 15.1%, and the lower lobe lung metastasis accounted for 53.1%. Conclusion Lymph node metastasis of lung cancer has jump and multiple. Increased tumor size and increased frequency of out-going lymph node metastases increased the frequency of adenocarcinoma metastasis compared with squamous cell carcinoma. Lung cancer at any site can be transferred across the mediastinum. Except for T1 squamous cell carcinoma, only radical removal of the lung and ipsilateral mediastinal lymph nodes can achieve the goal of radical cure.