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1、华 中 科 技 大 学 硕 士 学 位 论 文分 类 号 学号 2006865000016 学校代码 10487 密级 硕士学位论文肺癌纵隔淋巴结转移及前哨淋巴结的研究 学位申请人:王华斌学 科 专 业:胸心外科指 导 教 师:潘铁成 教授答 辩 日期:2013年10月42A dissertation submitted to Huazhong University ofScience and Technology for the Degree ofMaster of MedicineStudy of the mediastinal lymph node metastasis and sent
2、inel lymph nodes of lung cancerCandidate : Wang huabinMajor : Cardiothoracic SurgerySupervisor : Prof. Pan Tiecheng MD, PhDHuazhong University of Science & TechnologyWuhan 430074, P. R. ChinaOct, 2013独创性声明本人郑重声明,本学位论文是本人在导师指导下进行的研究工作及取得的研究成果的总结。尽我所知,除文中已经标明引用的内容外,本论文不包含任何其他个人或集体已经发表或撰写过的研究成果。对本文的研究做
3、出贡献的个人和集体,均已在文中以明确方式标明。本人完全意识到本人将承担本声明引起的一切法律后果。学位论文作者签名:日期: 年 月 日学位论文版权使用授权书本学位论文作者完全了解学校有关保留、使用学位论文的规定,即:学校有权保留并向国家有关部门或机构送交论文的复印件和电子版,允许论文被查阅和借阅。本人授权华中科技大学可以将本学位论文的全部或部分内容编入有关数据库进行检索,可以采用影印、缩印或扫描等复制手段保存和汇编本学位论文。保密 ,在_年解密后适用本授权书。本论文属于不保密。(请在以上方框内打“” )学位论文作者签名: 指导教师签名: 日期: 年 月 日 日期: 年 月 日目 录中文摘要1Ab
4、stract3肺癌纵隔淋巴结转移及前哨淋巴结的研究6前 言6资料与方法9结 果10讨 论15结 论20参考文献21综述 非小细胞肺癌纵隔淋巴结转移规律及前哨淋巴结的研究23致 谢42肺癌纵隔淋巴结转移及前哨淋巴结的研究中文摘要目的:(1) 通过系统采样或完全性纵隔淋巴结清除术将肺癌淋巴结分组,对各组淋巴结进行病理检查,记录每组淋巴结转移的比例,找出各个肺叶淋巴结转移的规律,以利于以后的临床工作有目的的清除纵隔淋巴结。(2) 通过淋巴结的分组,探讨肺癌原发肿瘤的大小及外侵、肿瘤发生的部位、病理类型与淋巴结转移的规律。方法本组159例患者来自我院2007年4月至2009年5月有选择性行系统采样或完
5、全性纵隔淋巴结清除术且资料比较齐全的肺癌病人。其中男118人,女41人;年龄21-74岁,平均年龄55.2岁。低分化癌33例,中分化癌107例,高分化癌12例,未分化小细胞癌7例。鳞癌47例,腺癌80例,腺鳞癌7例,小细胞癌7例,其他类型的肺癌18例。左上肺标本40例,左下肺26例;右上肺标本41例,右中、下肺52例。本组病例共清除肺门及纵隔淋巴结1521枚,其中阳性淋巴结250枚。结果159例肺癌术中共清扫胸内淋巴结1521枚,平均每例约9.6个,通过病理证实的转移淋巴结250枚,占淋巴结总个数的16.44%,胸内淋巴结转移的病例73例。其中,单纯转移到同侧支气管旁和(或)同侧肺门淋巴结的病
6、例(N1)26例,同时转移到同侧纵隔的病例(N1+N2)30例,另有单纯N2转移17例。总转移率为45.91%(73/159),跳跃性转移率为10.69%(17/159)。结论1.肺癌的淋巴结转移有其特殊的规律,与原发肿瘤大小、外侵程度、病理类型、肿瘤发生部位均有密切关系。随着肺癌瘤体的增大及外侵,淋巴结转移率逐渐增加;腺癌转移率显著高于鳞癌,女性易患腺癌,男性鳞癌发病率高;跳跃性转移被认为是纵隔淋巴结转移中预后较好的一个亚群,在肺癌纵隔淋巴结转移中经常发生,与肺内淋巴结转移一样,它应该是淋巴结的第一站转移。隆突下淋巴结是肺癌患者都容易转移的纵隔淋巴结,对于下叶肺癌是主要的纵隔转移淋巴结,左上
7、肺叶肿瘤最多转移到主动脉弓下、弓旁淋巴结,右上肺癌主要转移到上淋巴结区。2.肺癌前哨淋巴结大多位于肺内,跳跃到纵隔其前哨淋巴结主要位于隆突下淋巴结,右肺上叶和中叶癌也可出现在上纵隔;右肺下叶癌的前哨淋巴结也可位于下纵隔;左肺上叶癌的前哨淋巴结也可位于上纵隔;左肺下叶癌的前哨淋巴结上下纵隔均有分布。然而肺癌的前哨淋巴结可能偏离通常的引流方式。最确切明确前哨淋巴结的方法是在肺癌淋巴结转移规律的指导下利用前哨淋巴结外科导航技术,同时结合术前影像学的检查特别是18F-FDG PET/CT对非小细胞肺癌区域阳性淋巴结的诊断。3.我们认为由于现代科学技术的不断发展,胸腔镜及前哨淋巴结导航技术的开展,现代分
8、子生物学技术在病理诊断上的应用,肺癌纵隔淋巴结的清扫也应该采用个体化的治疗对策,减少手术创伤,明确手术目的,完善手术范围,以改善病人的生存质量,延长病人的生存时间,提高肺癌的治愈率。关键词:肺癌,纵隔淋巴结,转移,前哨淋巴结Study of the mediastinal lymph node metastasis and sentinel lymph nodes of lung cancerAbstractObjective: 1. To divide the lung cancer lymph nodes into different groups through the systemat
9、ic sampling or complete mediastinal lymph nodes dissection, and the pathologic examination was carried out in every group to record the proportion of lymph node metastasis and find out its pattern in every lung lobe to facilitate the future clinical work of mediastinal lymph node dissection on purpo
10、se. 2.To discuss the size and invasion of primary tumors, the occurrence site and pathological type of tumors and the pattern of lymph node metastasis by grouping of lymph nodes.Methods:The 159 patients of this group were selectively and systematically sampled or performed with the complete mediasti
11、nal lymph node dissection in our hospital from April 2007 to May 2009 and data of these patients were relatively complete. And there were 118 males and 41 females aged from 21 to 74 years with an average age of 55.2 years. There were 33 cases of poorly differentiated cancers, 107 cases of moderately
12、 differentiated cancers, 12 cases of well differentiated cancers, 47 cases of squamous cell carcinoma, 80 cases of adenocarcinoma, 7 cases of adenosquamous carcinoma, 7 cases of small cell carcinoma and 18 cases of lung cancer with other types. There were 40 cases of upper left lung specimens, 26 ca
13、ses of lower left lung specimens, 41 cases of upper right lung specimens and 52 cases of upper and lower right lung specimens. There were 1521 cases of hilar and mediastinal lymph nodes dissected and 250 cases were found to be positive.Results:A total of 1521 intrathoracic lymph nodes were dissected
14、 in 159 cases of lung cancer surgery with an average of 9.6 per case. Two hundred and fifty lymph nodes were confirmed by the pathology to have metastasis, accounting for 16.44% of the total number of lymph nodes, and there were 73 cases of intrathoracic lymph node metastasis. Among them, 26 cases h
15、ad simple metastasis to the same side beside the bronchi and/or to the ipsilateral hilar lymph nodes (N1), 30 cases had further metastasis to the ipsilateral mediastinal (N1 + N2) and 17 cases had other simple N2 metastasis. The total metastasis rate was 45.91% (73/159), and the skip metastasis rate was 10.69% (17/159).Conclusion:1. The lymph node metastasis of lung cancer