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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 explore the theoretical basis for the rational application of bronchoplasty in the treatment of lung cancer from the perspective of pathology. Methods The pathological study of different sections of 58 cases of bronchial lung resection specimens of lung cancer were performed. Results The proportion of residual cancer in resection was significantly higher in wedge resection than in sleeve resection (P<0.01). In 96.1% of the cases, the cancer infiltration occurred on the bronchial wall within 1.5 cm from the tumor margin. There were 3.9%, 23.5%, and 72.5% of cancer cells directly infiltrating along the mucosal layer, submucosa, or multi-layers. The distance of invasion of cancer is closely related to the pathological type, infiltration pattern, and TNM staging of lung cancer. The indirect infiltration of the proximal bronchial wall adventitia by metastatic lymph nodes is most prominent in adenocarcinoma. Conclusions In order to obtain a radical resection, the safety margin of the bronchial excision margin from the tumor margin should, in principle, be longer than 1.5 cm. Sleeve resection and routine removal of hilar and mediastinal lymph nodes should be performed.