胸中下段食管鳞癌淋巴结转移趋势的研究  

作　　者：胡艳君[1] 赵宏光[2] 毛伟敏[2] 周鑫明[2] 陈奇勋[2] 蒋友华[2] 

机构地区：[1]温州医学院,325000 [2]浙江省肿瘤医院胸腹外科,310022

出　　处：《浙江临床医学》2009年第11期1147-1150,共4页Zhejiang Clinical Medical Journal

摘　　要：目的了解胸中下段食管鳞癌淋巴结转移趋势，探讨合理的淋巴结清扫范围。方法回顾性分析浙江省肿瘤医院胸腹外科收治的933例胸中下段食管鳞癌患者的临床及病理资料，应用χ^2检验进行样本率及构成比的比较。结果933例患者中517例经病理学证实存在淋巴结转移（转移率55．4％），其中320例单独或合并存在腹腔淋巴结转移。全组总共清除淋巴结26118枚，转移2142枚（转移率8．2％），其中腹腔淋巴结清除12072枚，转移906枚。不同分段食管鳞癌淋巴结转移方向分布不同（χ^2=7．90，0．01〈P〈0．05），胸中段上行与下行转移的频度相当，胸下段下行转移多见，且胸下段腹腔淋巴结转移率及转移度均高于胸中段（χ^2=52．83，P〈0．01；χ^2=134．52，P〈0．01）。除7例Tis期食管鳞癌未发生淋巴结转移外，T，以后各期均可见淋巴结转移。不同T分期胸中下段食管鳞癌淋巴结转移方式分布不同（χ^2=18．12，0．05〈P〈0．01），病变浸润越深，发生连续性转移的机会越多，而病变浸润越浅，发生跳跃性转移的机会越多。结论胸中下段食管鳞癌淋巴结清扫范围应参照淋巴结转移趋势，结合术前检查结果，合理地选择。同时，应重视腹腔淋巴结的清扫，尤其胸下段癌。Objective To study the direction and pattern of lymph node metastasis in middle and lower thoracic esophageal squamous carcinoma, and find reasonable dissecting extent of lymph node. Methods To analyse retrospectively the clinical and pathological data of 933 patients with middle or lower thoracic esophageal squamous carcinoma who had undergone esophagectomy plus lymph node dissection in Zhejiang Cancer Hospital. Sample rate and constituent ratio comparisons were clone with χ^2 test. Result There were 517 lymphatic metastatic cases confirmed by pathology in 933 patients with middle or lower thoracic esophageal squamous carcinoma, within them isolated or combinecongenital celiac lymph node metastasis was found in 320 cases. Altogether 26118 lymph nodes were dissected, 2142 were metastatic ones. The number of celiac lymph node dissected was 12072, within them the metastatic were 906. The lymph node metastasis rate was 55.4% （517/933） and lymph node metastasis ratio was 8.2% （2142/ 26118 ）. There was difference in distribution of the direction of lymph node metastasis among the patients of different segments（ χ^2 = 7.90,0. 01 〈 P 〈 0. 05 ）. Upward and downward transition frequencies were balanced in middle thoracic esophageal squamous carcinoma, however, downward transition frequency was higher in lower cases and celiac lymph node metastasis rate and ratio of lower cases were higher than that of middle cases（ χ^2 =52.83 ,P 〈0. 01 and χ^2 = 134. 52 ,P 〈0. 01 ）. No lymph node metastasis was found in the 7 patients of Tis stage, while lymph node metastasis was found in the patients of other stages. Different T stages of middle or lower thoracic esophageal squamous carcinoma had significantly different distribution of the pattern of lymph node metastasis. The deeper invasion by the tumor, the higher frequency of continuous metastasis development, and vice versa, skip metastasis was more likely to occur where tumor invasion was less severe. Conclution Choosing reasonable scope of lymph node d

关 键 词：胸中下段食管 鳞状细胞癌 淋巴结转移 淋巴结清扫术 

分 类 号：R735.2[医药卫生—肿瘤] R608[医药卫生—临床医学]