胸腔镜食管癌切除术中广泛纵隔淋巴结清扫的可行性与安全性  

Feasibility and safety of radical mediastinal lymphadenectomy in thoracoscopic esophagectomy foresophageal cancer

作　　者：张毅[1] 谭黎杰[1] 冯明祥[1] 汪灏[1] 王群[1] 

机构地区：[1]复旦大学附属中山医院胸外科,上海200032

出　　处：《中华肿瘤杂志》2012年第11期855-859,共5页Chinese Journal of Oncology

摘　　要：目的探讨胸腔镜食管癌切除术中广泛纵隔淋巴结清扫的可行性和安全性。方法回顾性分析147例患者在胸腔镜食管癌切除术中纵隔淋巴结清扫及围手术期的临床资料。其中76例行扩大淋巴结清扫（扩大清扫组），即在常规淋巴结清扫（食管旁、隆突下淋巴结）的基础上，增加了上纵隔尤其是双侧喉返神经链淋巴结的清扫；71例仅行常规淋巴结清扫（常规清扫组）。比较两组患者的淋巴结清扫情况、淋巴结转移率、手术时间、术中出血量和并发症情况。结果147例患者胸腔镜手术均顺利完成，无中转开胸。扩大清扫组和常规清扫组患者的手术时间分别为（89±32）min和（99±32）min，差异无统计学意义（P=0．064）；术中出血量分别为（152±108）ml和（107±82）ml，差异无统计学意义（P=0．261）。147例患者共清扫胸部淋巴结1644个，（11．2±5．9）个／例。其中扩大清扫组共清扫胸部淋巴结999个，（13．1±6．4）个／例；常规清扫组共清扫胸部淋巴结645个，（9．1±4．4）个／例，差异有统计学意义（P〈0．001）。147例患者中，胸部淋巴结转移36例，淋巴结转移率为24．5％，其中食管旁、隆突下、喉返神经旁的淋巴结转移率分别为19．7％（29／147）、3．4％（5／147）和17．1％（13／76）。扩大清扫组患者中，胸部淋巴结转移27例，淋巴结转移率为35．5％；常规清扫组患者中，淋巴结转移9例，淋巴结转移率为12．7％，差异有统计学意义（P=0．001）。1644个清扫的胸部淋巴结中，阳性淋巴结90个，淋巴结转移度为5．5％，其中食管旁、隆突下、喉返神经旁的淋巴结转移度分别为6．5％、2．4％和7．5％。147例患者中，有60例患者出现术后并发症，并发症发生率为40．8％。两组患者不同并发症的发生率差异均无统计学意义（P〉0．05）。结论胸腔镜食管癌切除术中行Objective To explore the feasibility and safety of radical mediastinal lymphadenectomy in thoracoscopic esophagectomy for esophageal cancer. Methods We retrospectively analyzed the clinical data of a cohort of 147 patients with esophageal cancer who underwent thoracoscopic esophagectomy. Seventy-one patients received traditional lymphadenectomy for the periesophageal and subcarinal lymph nodes （traditional dissection group）, while 76 patients received radical lymph node dissection for the bilateral recurrent laryngeal nerve lymphatic chains as well as the peri^sophageal and subcarinal nodes （radical dissection group）. The number of retrieved lymph nodes, incidence of node metastasis, the operation time, estimated blood loss, complications, mobidity and mortality were compared between the two groups. Results Thoracoscopic esophagectomy was completed in all patients with no conversion to thoracotomy. There were no significant differences of operational time and blood loss between the two groups [ （89 ＋32）min versus （99 ＋ 32）min, P=0.064; （152 ＋ 108） ml versus （107 ＋82）ml, P =0. 261]. In all patients, the total and average number of retrieved mediastinal nodes were 1644 and 11.2 ± 5.9/case, and the incidence of metastatic lymph nodes was 24.5%. The total and average number of retrieved mediastinal nodes were 999 and 13. 6 ± 6. 4/case in the radical dissection group, significantly higher than that in the traditional dissection group （645 and 9.1 ±4.4/case） （P 〈 0.001 ）. The average number of retrieved nodes and node metastasis rate in the radical dissection group were significantly higher than in the traditional dissection group（13.1 ±6.4 versus 9.1 ±4.4,P〈0.001;35.5% versus 12.7%,P〈0.05）. In the total group of 147 cases, the metastasis rates of periesophageal, subcarinal nodes and nodes along the recurrent laryngeal nerve lymphatic chains were 19.7%, 3.4% and 17.1% , respectively. There was thoracic lymph node metastasis in 27 cases with a metastasis rate of 35.

关 键 词：食管肿瘤 胸腔镜 食管切除术 淋巴结切除术 可行性 安全性 并发症 

分 类 号：R735.1[医药卫生—肿瘤]