摘要
目的 从病理学角度探索合理应用支气管成形术治疗肺癌的理论依据。方法 对58例肺癌支气管成形肺切除标本近侧支气管进行不同断面的病理学研究。结果 楔形切除术患者中切端癌残留的比例显著高于袖状切除者(P<0.01)。96.1%的病例癌浸润发生在距瘤缘1.5cm以内的支气管壁上。癌细胞沿管壁粘膜层、粘膜下层或多层面直接浸润者分别占3.9%、23.5%与72.5%。癌浸润距离与肺癌病理类型、浸润方式及TNM分期有密切关系。转移淋巴结对近侧支气管壁外膜层的间接浸润以腺癌最为突出。结论 为获得根治性切除,支气管切端距瘤缘的安全界限原则上应在1.5cm以远,并须选择袖状切除术式及常规彻底清除肺门、纵隔淋巴结。
Objective To investigate the characteristics of proximal bronchial invasion of lung cancer, and to provide some insights into the treatment of lung cancer by bronchoplasty. Methods Proximal bronchi of 58 operatively resected specimens of lung cancer by bronchoplasty were selected for different cross sectional pathological study.Results The ratio of cancer remnant of incision margin in the patients of bronchial wedge resection was significantly higher than that of sleeve resection (P<0.01). Of the cancerous invasion at the proximal bronchial wall, 96.1% was observed to be less than 1.5cm apart from the margin of the cancer. The direct invasion of tumour cells through the mucous layer, submucosal layer and multiple layers was 3.9%, 23.5% and 72.5% respectively. The extension of cancer infiltration was closely correlated with the histopathologic type of cancer, mode of invasion and TNM staging. The indirect invasion of metastatic lymph nodes in adenocarcinoma was more likely at the adventitial layer of proximal bronchial wall. Conclusion For radical operation, it is imperative to keep a distance of 1.5cm or more between the incision margin of the bronchus and the tumor margin, to take sleeve lobectomy or pneumonectomy and to completely clear the hilar and mediastinal lymph nodes.
