胸段食管癌重点清扫淋巴结的临床病理特点及预后分析  

The clinicopathologic characteristic and prognosis analysis of lymphadenectomy in thoracic esophageal carcinoma

作　　者：陈远岷 刘德森[1] 潘琪[1] 黄明芳[1] 黄重庆[1] 

机构地区：[1]广西医科大学附属肿瘤医院胸外科,南宁530021

出　　处：《中华临床医师杂志（电子版）》2014年第13期28-31,共4页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的：探讨手术重点清扫淋巴结的临床病理特点及预后，为规范化清扫提供参考。方法对515例胸段食管癌手术患者的临床资料进行分析，重点研究隆突下、食管旁、胃左动脉旁三组重点清扫淋巴结与临床病理因素间的单因素和多因素分析及预后情况。结果单因素和多因素分析显示：隆突下淋巴结转移与肿瘤长度、分化程度和浸润深度有关（P＜0.05）；食管旁淋巴结转移与肿瘤浸润深度有关（P＜0.05）；胃左动脉旁淋巴结转移与肿瘤部位、分化程度和浸润深度有关（P＜0.05）。生存分析显示：在N1-3患者，食管旁、胃左动脉旁淋巴结的清扫组与未清扫组相比，其1、3、5年生存率均有显著差异（P＜0.05）。结论胸段食管癌应尽可能对转移率较高的食管旁和胃左动脉旁淋巴结清扫彻底。对病变侵及食管全层或病变长度＞3 cm的患者应常规实施隆突下淋巴结的彻底清扫。在N1-3患者中，行食管旁、胃左动脉旁淋巴结清扫能提高患者的生存率。Objective To study the clinicopathologic characteristic and prognosis status and provide the references for standard lymphadenectomy.MethodsThe clinical data of 515 patients with thoracic esophageal carcinoma were analyzed to get knowledge of the relationship between lymphadenectomy and clinicopathologic characteristic and prognosis status in subcarinal, para-esophageal and left gastric artery.Results Univariate and multivariate analysis showed that subcarinal lymph node metastasis was significantly associated with tumor size, degree of differentiation and depth of invasion （P〈0.05）. The para-esophageal lymph node metastasis was significantly associated with depth of invasion and left gastric artery lymph node metastasis was also significantly associated with tumor location, tumor differentiation and depth of invasion （P〈0.05）. For N1-N3 patients, the survival analysis showed that there was obvious difference in one-year, three-year and five-year survival rate between patients who conducted lymphadenectomy of para-esophagus, left gastric artery and patients who did not perform those. Conclusions Because of their high metastasis rate, thoracic esophageal carcinoma should be conducted lymphadenectomy in para-esophagus and left gastric artery as far as possible. The subcarinal lymphadenectomy should be conducted in patients who’s full thickness of esophageal have been invaded or l who＇s lesion length 〉3 cm. For patients with N1-N3, conducting lymphadenectomy of para-esophagus, left gastric artery could improve the survival rate of patients with thoracic esophageal carcinoma.

关 键 词：食管肿瘤 淋巴转移 预后 

分 类 号：R735.1[医药卫生—肿瘤]