胸中段食管癌淋巴结二野清扫术和三野清扫术的比较  

Comparison of two-field dissection and three-field dissection in esophageal chest lymph node dissection

作　　者：闫进 

机构地区：[1]解放军第一五九医院心胸外科,河南驻马店463000

出　　处：《中国实用医刊》2014年第23期43-45,共3页Chinese Journal of Practical Medicine

摘　　要：目的 探讨二野清扫术和三野清扫术在胸中段食管癌淋巴结中的应用.方法 选择解放军第一五九医院肿瘤科2013年1月至2014年1月收治的胸中胸段食管癌患者100例,随机分为二野组和三野组,每组50例.二野组采用二野淋巴结清扫术联合Ivor-Lewis术,三野组采用三野淋巴结清扫术联合Akiyama术,对效果进行比较.结果 二野组总淋巴结清扫数量为950个,范围8 ～ 39个,观察淋巴结转移数目共86个;三野组在总淋巴结清扫数为1500个,范围16 ～ 62个,观察淋巴结转多数目共80个;淋巴结转移在二野组的发生率为48％,三野为70％,差异有统计学意义（P＜0.05）.二野组纵隔加胃周淋巴结转移率为50％,三组为44％;二野组腹腔干淋巴结转移率为4％,三野组为6％,差异均无统计学意义（P＞0.05）.二野组中下纵隔淋巴结转移率为32％,三野组为24％,差异有统计学意义（P＜0.05）.二野组颈部淋巴结转移率无法评估,三野组为42％.组间上纵隔和颈部淋巴结转移率比较差异有统计学意义（P＜0.05）..二野组淋巴结转移3.3个,三野组为2.8个,均以1～10个为范围,差异无统计学意义（P＞0.05）.二野组平均清扫淋巴结17.0个,三野组为32个,差异有统计学意义（P＜0.05）.二野组淋巴结转多度为10％,明显高于三野组（6％）,二野组转移平度为20％,明显高于三野组（10％）,差异有统计学意义（P＜0.05）.结论 行二野淋巴结清扫时,需对左喉返神经旁淋巴结进行较好清扫,三野淋巴结清扫术预后可能更为理想,对颈部和纵隔的转移淋巴结可彻底清除,对于腹腔淋巴结,清扫颈部和纵隔转移淋巴结意义重大,可显著改善胸中段食管癌的预后.Objective To study the application of two-field dissection and three-field dissection in esophageal dissection.Methods From January 2013 to January 2014,100 patients with thoracic esophageal carcinoma in our hospital were randomly divided into two-field group and three-field group,with 50 cases in each group.The patients in two-field group received two-field lymphadenectomy joint with Ivor-Lewis surgery,and the patients in three-field group received three-field lymphadenectomy combined with Akiyama surgery,the clinical effects were compared.Results Two wild group statistics show the total number of lymph node dissection was 950,ranged 8-39 months,the number of metastatic lymph nodes was observed,a total of 86 ; three wild groups in the total number of lymph node dissection was shown by the statistics of 1500,the range of 16-62 months to observe the lymph nodes turn more than the number of 80 ; statistical incidence of lymph node metastasis in two wild group was 48％,three wild was 70 ％,there was significant difference between the two groups （P ＜ 0.05）.Plus two wild groups of mediastinal lymph node metastasis of gastric rate of 50％,the three groups was 44％ ; two wild celiac lymph node metastasis group was 4％,6％ for the three wild group,there was no significant difference（P ＞ 0.05）.Two wild group under the mediastinal lymph node metastasis was 32 ％,three wild group was 24％,there was significant difference（P ＜0.05）.Two wild group of cervical lymph node metastasis can not be assessed,three wild group was 42％.Between groups and mediastinal lymph node metastasis rate of major differences.Two-field lymph node metastases 3.3,the statistical showing three wild group 2.8,are in the range of 1 to 10,there was no significant difference（P ＞0.05）.Two-field lymph node dissection group was 17.0,after statistics show three wild group 32,there was significant difference （P ＜0.05）.Two wild group of lymph node degrees is 10％,significantly higher than the three wild groups of 6％ in t

关 键 词：胸中段 食管癌 淋巴结 二野清扫术 三野清扫术 对比 

分 类 号：R735.1[医药卫生—肿瘤]