186例Ⅱ、Ⅲ期食管中段、下段鳞癌淋巴结转移规律的临床分析  

Clinical significance analysis of lymph node metastasis on the middle and lower segment of 186 cases of Ⅱ and Ⅲ stage of esophageal squamous cell carcinoma patients

作　　者：王学智[1] 洪智攀[1] 郭峰[1] 闫文强[1] 祁振国[1] 李世君[2] 刘震[3] 

机构地区：[1]内蒙古医科大学赤峰临床医学院消化道肿瘤外科,内蒙古自治区赤峰024000 [2]内蒙古医科大学赤峰临床医学院病理科,内蒙古自治区赤峰024000 [3]内蒙古医科大学赤峰临床医学院妇科,内蒙古自治区赤峰024000

出　　处：《中国医师杂志》2015年第1期74-77,共4页Journal of Chinese Physician

摘　　要：目的探讨Ⅱ、Ⅲ期食管中段、下段鳞癌淋巴结转移规律，并了解其影响因素，进一步探讨食管癌淋巴结重点清扫区域的证据。方法回顾性分析2010年4月至2013年12月内蒙古医科大学赤峰临床医学院186例Ⅱ、Ⅲ期食管中段、下段鳞癌经左胸、胸腹二野淋巴结清扫食管癌根治术的临床资料。结果本组病例共清扫淋巴结4259枚，平均每例清扫（22．9±8．1）枚，其中126例发生淋巴结转移，转移率67．7％，转移淋巴结622枚，转移度14．6％；食管中段、下段食管癌中纵隔转移率56．1％和16．5％，下纵隔转移率34．6％和54．4％，腹腔转移率23．4％和46．8％；中段和下段食管癌转移部位差异有统计学意义（P〈0．05）；食管中段鳞癌淋巴结转移部位前三位分别是食管旁、隆突下、胃左动脉旁淋巴结，而食管下段鳞癌淋巴结转移部位前三位分别是食管旁、贲门旁、胃周淋巴结。肿瘤浸润深度、分化程度、脉管内癌栓对淋巴结转移率的影响有统计学意义（P〈0．05），肿瘤所在部位、病变的长度对淋巴结转移率的影响无统计学意义（P〉0．05）。结论Ⅱ、Ⅲ期食管下段鳞癌淋巴结转移以下纵隔及腹腔淋巴结多见，而食管中段鳞癌淋巴转移胸、腹腔均多见，出现跳跃性转移特点，对于中段食管癌清扫重点清扫食管旁、隆突下、胃左动脉旁淋巴结，而下段食管癌重点清扫食管旁、贲门旁及胃周淋巴结；肿瘤浸润深度越深、分化程度越低、脉管内有癌栓转移率越高。Objective To investigate lymph node metastasis on the middle and lower segment of Ⅱ and Ⅲ stage of esophageal squamous cell carcinomas, understand the factors influencing the lymph node metastasis, and provide the basis for the key areas of lymph node cleaning. Methods A retrospective study was made on the specimens of 186 patients who were middle and lower segment of Ⅱ and Ⅲ stage of esoph- ageal squamous cell carcinomas, who had underwent radical operation through left thoracic, thoraco abdominal two field lymph node cleaning. All the cases were patients from April 2010 to December 2013 at the In-ner Mongolia Medical University Clinical Medical College of Chifeng. Results A percentage （67.9%） of patients （126/186） was found with lymph node metastasis. A total of 4259 lymph node was dissected, with an averaged cleaning of （22.9 ± 8.1） lymph nodes for each case. A total of 622 lymph nodes （ 14. 6% = 622/4 259） existed metastasis. The rate of mediastinum metastasis for middle and lower segment of esopha- geal cancer was 56. 1% and 16. 5%, respectively. The rate of metastasis to the lower mediastinal lymph nodes was 34. 6% and 54. 4%, respectively. The rate of metastasis to the celiac lymph nodes was 23.4% and 46. 8% , respectively. A significant difference was found in the metastasis locations of middle and lowersegment of esophageal carcinomas （ P 〈 0. 05）. The top three locations of lymph node metastasis in the middle segment of esophageal squamous cell carcinomas were the lymph nodes of left artery paraesophageal, carina, and gastric bypass. The top three locations of lymph node metastasis in the lower segment of esopha- geal squamous cell carcinomas were paraesophageal, cardia, and gastric lymph nodes. The depths of tumor invasion, differentiation, intravascular cancer embolus were statistically significant effect on lymph node me- tastasis rate （ P 〈 0. 05 ）. Tumor location, and lesion length had no significant effect on the lymph node metastasis rate （ P 〉 0. 05）. C

关 键 词：食管肿瘤/病理学 肿瘤 鳞状细胞/病理学 淋巴转移 回顾性研究 

分 类 号：R735.1[医药卫生—肿瘤]