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目的探讨非小细胞肺癌肺内淋巴结转移的规律以及检测肺内第12、第13组淋巴结的临床意义。方法选取2015年1~6月间在四川省肿瘤医院胸外科接受标准肺癌根治手术及系统性淋巴结清扫术的患者38例,其中男29例、女9例,年龄44~73(61.1±15.4)岁;鳞癌20例,腺癌17例,肉瘤样癌1例;所有患者术前未进行放、化疗。对术后标本内的肺内淋巴结进行取材并标记所有淋巴结进行病理检测。结果共取得淋巴结652枚,平均每例17.2枚。转移淋巴结共78枚,转移度为12.0%。24例出现淋巴结转移,转移率为63.2%。其中N_1 22例,N_1+N_2 10例,跳跃性N_2 2例。38例患者中共检出第12、13组淋巴结转移者12例,转移率为31.6%。共清扫第12、第13组淋巴结95枚,14枚转移,转移率为14.7%。常规病理检测无纵隔及肺内淋巴结转移患者18例中检出单纯第12、第13组淋巴结转移者4例,检出率为22.2%(4/18),N_1淋巴结漏诊率为33.3%(4/12)。单因素和多因素分析提示肺内第12、第13组淋巴结转移率与肿瘤的分化程度有关(χ~2=6.453,P=0.011),与病理类型(χ~2=0.118,P=0.732)、肿瘤大小(χ~2=0.930,P=0.759)及肿瘤分型(χ~2=1.648,P=0.199)无关。结论肺内淋巴结在肺癌转移过程中占据相当的比例,对于非小细胞肺癌尤其分化程度较低的患者应常规进行病理检测,以提高肺癌分期的准确率。
Objective To investigate the regularity of intrapulmonary lymph node metastasis in non-small cell lung cancer (NSCLC) and the clinical significance of detecting lymph nodes in the twelfth and thirteenth groups in the lung. Methods Thirty-eight patients, including 29 males and 9 females, aged from 44 to 73 (range, 61.1 ± 15.4 years) undergoing radical surgery for lung cancer and systemic lymphadenectomy in the Department of Thoracic Surgery, Sichuan Cancer Hospital from January to June 2015, Years; squamous cell carcinoma in 20 cases, adenocarcinoma in 17 cases, sarcomatoid carcinoma in 1 case; all patients without preoperative radiotherapy and chemotherapy. The intrapulmonary lymph nodes in the postoperative specimens were drawn and all the lymph nodes were labeled for pathological examination. Results A total of 652 lymph nodes were obtained, with an average of 17.2 cases per case. A total of 78 metastatic lymph nodes, the degree of transfer was 12.0%. 24 cases of lymph node metastasis, the transfer rate was 63.2%. There were 22 cases of N_1, 10 cases of N_1 + N_2 and 2 cases of jumping N_2. Among the 38 patients, 12 cases of lymph node metastasis in Group 12 and 13 were detected, with a metastasis rate of 31.6%. A total of 95 lymph nodes in group 12 and group 13 were dissected, with 14 metastases and 14.7% metastasis. Routine pathological examination of the mediastinal and intrapulmonary lymph node metastases detected in 18 cases of simple group 12, 13 cases of lymph node metastasis in 4 cases, the detection rate was 22.2% (4/18), N 1 lymph node misdiagnosis rate was 33.3% (4 / 12). Univariate and multivariate analysis showed that the rates of lymph node metastasis in group 12 and group 13 were correlated with tumor differentiation (χ ~ 2 = 6.453, P = 0.011), but not with pathological type (χ ~ 2 = 0.118, P = 0.732) , Tumor size (χ ~ 2 = 0.930, P = 0.759) and tumor type (χ ~ 2 = 1.648, P = 0.199). Conclusions The intrapulmonary lymph nodes account for a considerable proportion of patients with lung cancer metastasis. For patients with non-small cell lung cancer, especially those with lower degree of differentiation, routine pathological examination should be performed to improve the accuracy of lung cancer staging.