Ayabe H, Tsuji H, Nakamura A, Takahashi T, Matsuo S, Akamine S, Tagawa Y, Kawahara K, Tomita M
First Department of Surgery, Nagasaki University School of Medicine, Japan.
Kyobu Geka. 1994 Jan;47(1):28-32.
To establish a reasonable regional lymph node dissection as curative operation for lung cancer, hilar and mediastinal lymph node metastases were analyzed. From 1982 to December, 1990, 404 patients underwent pulmonary resection with complete mediastinal node dissection. There were 194 adenocarcinomas, 175 squamous cell carcinomas, 14 large cell carcinomas, 13 small cell carcinomas and 8 others. The rates of hilar (N1) and mediastinal lymph node (N2) metastasis were 12.4% and 28.9% in adenocarcinoma, 12.6% and 30.3% in squamous cell carcinoma, 14.2% and 28.6% in large cell carcinoma and 15.4% and 30.8% in small cell carcinoma. In cases with adenocarcinoma, there was a close relationship between mediastinal metastasis and grade. No lymph node metastasis was seen in cases with tumor less than one cm in diameter. However, mediastinal node metastasis was found in cases with one cm or more in diameter of primary lesion and rates of metastasis were increased in proportion to tumor size. Because considerable metastases are found in the mediastinal lymph nodes and exact diagnosis of node metastasis before and during operation is difficult, complete mediastinal node dissection is still standard as curative resection for resectable lung cancer except lesion less than one cm in diameter or early hilar type squamous cell carcinoma.
为确立合理的区域淋巴结清扫术作为肺癌的根治性手术，对肺门及纵隔淋巴结转移情况进行了分析。1982年至1990年12月，404例患者接受了纵隔淋巴结完全清扫的肺切除术。其中腺癌194例，鳞癌175例，大细胞癌14例，小细胞癌13例，其他8例。腺癌的肺门（N1）和纵隔淋巴结（N2）转移率分别为12.4%和28.9%，鳞癌分别为12.6%和30.3%，大细胞癌分别为14.2%和28.6%，小细胞癌分别为15.4%和30.8%。在腺癌病例中，纵隔转移与分级密切相关。直径小于1cm的肿瘤病例未见淋巴结转移。然而，原发灶直径在1cm及以上的病例发现有纵隔淋巴结转移，且转移率随肿瘤大小成比例增加。由于在纵隔淋巴结中发现相当数量的转移，且术前及术中对淋巴结转移的准确诊断困难，除直径小于1cm的病变或早期肺门型鳞癌外，纵隔淋巴结完全清扫术仍是可切除肺癌根治性切除的标准术式。
