胸段食管癌左右胸入路清扫淋巴结的结果比较  

Comparison of the results of lymph node dissection via left versus right tlmracotomy

作　　者：毛友生[1] 赫捷[1] 董静思[1] 程贵余[1] 孙克林[1] 刘向阳[1] 方德康[1] 李鉴[1] 王永刚[1] 

机构地区：[1]中国医学科学院北京协和医学院肿瘤医院胸外科,100021

出　　处：《中华肿瘤杂志》2012年第4期296-300,共5页Chinese Journal of Oncology

摘　　要：目的比较同期左右胸人路胸段食管癌胸腹二野淋巴结清扫的结果，以明确左、右胸入路清扫淋巴结的差别。方法随机选取中国医学科学院肿瘤医院2005年5月至2011年1月，行外科手术治疗的胸段食管癌患者559例，其中左胸入路282例，右胸人路277例；鳞癌548例，其他类型11例；肿瘤位于胸上段109例，胸中段364例，胸下段86例。采片，检验比较各期别、各部位、各淋巴结组左、右胸入路淋巴结转移阳性率的差异。对术后5年以上的患者进行随诊，计算左、右胸入路手术治疗食管癌患者的5年生存率。结果左胸入路和右胸人路患者平均清扫淋岂结数分别为23．4和24．6枚。左胸人路和右胸入路患者胸部淋巴结的转移率分别为34．8％（98／282）和50．5％（140／277，P〈0．001），腹部淋巴结的转移率分别为29．1％（82／282）和17．7％（49／277，P=0．001）。胸上、中、下段食管癌患者胸部淋巴结的转移率分别为45．9％、44．0％和34．9％，差异均无统计学意义（均P〉0．05）。T1期患者中，左胸入路和右胸入路患者的淋巴结转移率分别为14．7％（5／34）和42．9％（12／28，P〈0．001）。r12期患者中，左胸人路和右胸人路患者的淋巴结转移率分别为35．4％（17／48）和52．8％（28／53，P=0．007）。右胸人路患者在左、右侧气管食管沟和左、右上纵隔及隆突下组清除淋巴结的转移率均明显高于左胸人路（均P〈0．05）。左胸入路和右胸人路患者的5年生仔率分别为38．2％和42．1％，差异无统计学意义（P=0．620）。结论右侧开胸较左侧开胸清除胸部淋巴结更彻底、更完全，尤其是对于清扫双侧气管食管沟和喉返神经旁的淋巴结，最终自町能改善患者生存。选择右胸入路二切口或三切口行完全的胸腹二野或三野淋巴结清扫可能成为胸段食管癌外科治疗的未来趋向。Objective Up to now surgical treatment has been still the most effective treatment for esophageal cancer. However, postoperative lymph node recurrence is still a frequent event and affects long term survival considerably. The aim of this study is to compare the results of lymph node dissection via left vs. right thoracotomies and to verify whether there is any essential difference in Iymphadenectomy between these two approaches. Methods Five hundred and fitiy-nine cases with thoracic esophageal cancer were randomly selected from the database of esophageal cancer patients who underwent surgical treatment in our hospital between May 2005 and January 2011, including 282 cases through left thoracotomy and 277 cases through right thoracotomy. This series consisted of 449 males and 110 females with a mean age of 58.8 years （age range： 36-78 years）. The pathological types were mainly squamous cell carcinoma （548 cases） and other rare types （ 11 cases ）. The data were analyzed and compared using Chi-square test. The P-value 〈 0.05 was considered as statistically significant. The actual 5-year survival rate was calculated based on the recent follow-up data of the patients who underwent surgery at least 5 years ago. Results The average number of dissected lymph nodes was 23.4 via left versus 24.6 via right thoracotomies. The overall lymph node metastasis rate was 48.9% via left thoracotomy and 53.8% via right thoracotomy, and 34.8% vs. 50. 5% in the chest （P〈0.001）, 29.1% vs. 17.7% in the abdomen （P =0. 001）. The pathologically confirmedlymph node metastasis rate was 45.9% , 44.0% and 34.9% in the upper, middle and lower segments of thoracic esophagus, respectively. The lymph node metastasis rates detected via left and right thoracotomy in the stage T1 cases were 14.7% （5/34） vs. 42.9% （12/28） （P 〈 O. 001 ）, and in the stage T2 cases were 35.4% （17/48） vs. 52.8% （28/53）（P =0.007）; in the station of para-thoracic esophagus were 9.6% vs. 13.4% ,in the left upper mediastinum

关 键 词：食管肿瘤 外科手术 淋巴结切除术 

分 类 号：R735.1[医药卫生—肿瘤]