胸中段食管癌胸腹双切口两手术野淋巴结清扫及其转移规律的临床研究  

Clinical research on thoraco-abdominal two-field lymph node dissection and regularity of metastasis inmiddle-third thoracic esophageal carcinoma

作　　者：曹志坤[1] 范利民[2] 

机构地区：[1]河南省商丘市第一人民医院胸外科,476100 [2]上海市胸科医院胸外科

出　　处：《中国综合临床》2013年第3期300-303,共4页Clinical Medicine of China

摘　　要：目的探讨胸中段食管癌胸、腹双切口手术野淋巴结转移清扫方法及其转移规律，指导临床实施淋巴结清扫的范围。方法62例胸中段食管癌采用右胸及上腹正中双切口术式为基础进行胸、腹两手术野淋巴结清扫，并对淋巴结转移特征进行分析。结果全组62例患者共清扫淋巴结505枚，其中检出有癌转移的淋巴结102枚，淋巴结转移率20．2％（102／505）。淋巴结转移区域特征为胸中段食管癌既有向上到右颈气管旁、双侧喉返神经链旁、食管旁、癌肿旁、隆突下淋巴结转移，也有向下至贲门旁、胃左动脉旁、胃小弯网膜等处淋巴结的转移，呈现双向转移趋势。肿瘤的浸润深度明显影响淋巴结转移，T1患者淋巴结转移率为10．O％（1／10），他为20．0％（3／15），T3为43．3％（13／30），T4为57．1％（4／7），差异有统计学意义（X2=18．56，P〈0．05），表明浸润深度越深，淋巴结转移率越高。高分化癌、中分化癌、低分化癌的淋巴结转移率分别为14．3％（2／14）、39．5％（15／38）、57．1％（4／7），差异有统计学意义（X2=17．75，P〈0．05）。结论胸中段食管癌患者淋巴结转移与肿瘤浸润深度及分化程度有关。右颈气管旁及双侧喉返神经链是淋巴结转移的重要区域，右胸及上腹双切口术式更方便胸中段食管癌切除和胸、腹两手术野淋巴结的清扫，并且以此为基础经右胸顶对右颈气管旁及双侧喉返神经链淋巴结清扫也是安全可行的。Objective To investigate the regularity of thoraco-abdominal two-field lymphatic metastasis and methods of the nodal dissection in middle-third thoracic esophageal carcinoma, and to guide the scope of the lymph-node clearance. Methods Thoraco-abdominal two-field lymph-node dissection based on surgical incisions of the right chest and middle upper abdomen were conducted in 62 cases with middle-third thoracic esophageal cancer and the regularity of nodal metastasis was analyzed. Results Five hundred and five pieces of lymph node were cleaned in all 62 patients and among them 102 pieces were detected as metastasis lymph node, the nodal metastasis ratio was 20. 2% （102/505）. The middle-third thoracic esophageal cancer not only includes the nodal metastases up to the trachea of the right neck, around the bilateral recurrent laryngeal nerve chains, near the esophagus and the tumor, and the lymph-node metastasis at the inferior tracheal protuberance, but also the nodal metastases down to the cardiac, around the left gastric artery and at the retina of the lesser curvature of the stomach etc, presenting a tendency of 2-way metastasis. The infiltration depth and differentiation of the tumor is of statistical significance on the nodal metastasis ratio. There was significant difference on the metastasis rate of lymph node from T1 to T4（T1：10. 0% （1/10） ,T2：20. 0% （3/15） ,T3：43.3% （13/30） ,T4：57. 1% （4/7）, X2 = 18. 56,P 〈0. 05）. It indicated that metastasis rate was increased with the development of the infiltration depth. There was significant difference on the metastasis rate of high differentiation carcinoma, moderate differentiation carcinoma and low differentiation carcinoma （14. 3% （2/14） vs 39. 5% （15/38） vs 57. 1% （4/7）, X2 = 17. 75,P 〈 O. 05 ）. Conclusion The lymph node metastasis of patients with middle-third thoracic esophageal carcinoma is significantly correlated with the depth of tumor invasion and the degree of differentiation,with the tendency of thoraco-abd

关 键 词：食管癌 淋巴结转移 手术野淋巴结清扫 

分 类 号：R735.1[医药卫生—肿瘤]