胸段食管癌喉返神经旁淋巴结清扫的技术要点与相关并发症的防治  

Key technology of lymph node dissection along recurrent laryngeal nerve and its associated complication prevention in patients with thoracic esophageal cancer

作　　者：毛友生 赫捷 高树庚 薛奇 袁立功 赵越 丁宁宁 Mao Yousheng;He Jie;Gao Shugeng;Xue Qi;Yuan Ligong;Zhao Yue;Ding Ningning(Department of Thoracic Surgery,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College,Beijing 100021,China)

机构地区：[1]国家癌症中心国家肿瘤临床医学研究中心/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》2019年第1期1-5,共5页Chinese Journal of Oncology

基　　金：国家十二五科技支撑计划(2015BA112808).

摘　　要：食管癌是我国高发肿瘤之一,淋巴结转移是影响食管癌预后的的最重要因素之一。胸腹二野食管癌引流区各站淋巴结完全清扫是改善食管癌患者预后的重要措施,也是进行准确术后病理分期和制定术后治疗方案的基础。由于喉返神经旁淋巴结尤其右侧后返神经旁淋巴结是胸段食管癌转移率最高的区域,因此,双侧喉返神经旁淋巴结清扫是食管癌胸部淋巴结清扫最重要的步骤。但双侧喉返神经旁淋巴结清扫会导致术后喉返神经损伤及肺部并发症增加等系列问题。因此,双侧喉返神经旁淋巴结清扫的得失是胸外科医师关注最多和最为纠结的问题之一,文章就双侧喉返神经旁淋巴结清扫的技术要点和相关并发症的防治进行了总结和评述。Esophageal cancer is one of the most prevalent cancers in China. Lymph node metastasis is one of the most important prognostic factors and severely affect the long-term survival after surgical treatment. Therefore, systemic two-field lymph node dissection including thoracic and abdominal draining nodes of the esophagus during surgery is essential in order to improve the long-term survival for the patients with thoracic esophageal cancer, and it is also the basis for precise staging and postoperative adjuvant treatment regimen- making. As reported in the literature, lymph node metastases along bilateral recurrent laryngeal nerve was the highest, therefore, the lymph node dissection along bilateral recurrent laryngeal nerve is the most important manipulation during esophagectomies, however, it is also the most technically difficult procedure during operation. It usually results in postoperative complications especially the respiratory complications due to paralysis of recurrent laryngeal nerves caused by lymph node dissection. Therefore, the gain and loss of lymph node dissection along bilateral recurrent laryngeal nerve has been a disputed and entangle topic for thoracic surgeons, and the purpose of this paper is to summarize author′s experience and the key technology to prevent the associated complications in lymph node dissection along recurrent laryngeal nerve during esophagectomies for the patients with thoracic esophageal cancer.

关 键 词：食管肿瘤 淋巴结清扫 喉返神经麻痹 肺部并发症 

分 类 号：R735.1[医药卫生—肿瘤]