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目的 从病理学角度探索肺癌纵隔淋巴结 (N2 )转移的特点。方法 为 3 98例肺癌患者施行根除性肺切除加淋巴结廓清术 ,对其中 160例N2 肺癌的 3 5 2组纵隔转移淋巴结进行病理学研究。结果 肺癌N2 转移可呈现单组、多组和跳跃式转移 ,分别占 41.2 %、5 8.8%和 2 9.3 %。N2 转移分布最密集的部位是第 7组淋巴结 ,占 48.8% ,其次是第 4、3、5组淋巴结 ,分别占 45 .6%、3 1.3 %和 2 5 .6% ;而且N2转移分布与肿瘤部位、大小、组织学类型及分化程度有密切关系。转移淋巴结对主支气管壁的侵袭是N2转移的又一特点 ,尤以腺癌为突出。结论 为获得根除切除 ,必须主动、系统地清除同侧胸腔肺门及上、下纵隔淋巴结 ,并应重视转移淋巴结对支气管壁的侵袭性。
Objective To explore the characteristics of metastasis of mediastinal lymph nodes (N2) in lung cancer from the perspective of pathology. Methods A total of 398 lung cancer patients underwent radical lung nephrectomy plus lymphadenectomy, and 352 of them were studied for pathological studies of metastatic lymph nodes in 352 patients with N2 lung cancer. Results The N2 metastasis of lung cancer can present with single group, multiple groups and skip transition, accounting for 41.2%, 58.8% and 29.3% respectively. The most dense site of N2 metastasis distribution was group 7 lymph nodes, accounting for 48.8%, followed by group 4, 3, and 5 lymph nodes, accounting for 45.6%, 31.3%, and 25.6%, respectively; and N2 metastasis was Tumor site, size, histological type and differentiation are closely related. The invasion of the main bronchial wall by metastatic lymph nodes is another feature of N2 metastasis, especially in adenocarcinoma. Conclusion In order to obtain radical excision, it is necessary to actively and systematically remove the pleural hilar and upper and lower mediastinal lymph nodes from the ipsilateral thoracic cavity, and attention should be paid to the invasion of the bronchial wall by metastatic lymph nodes.