食管胃交界区腺癌的淋巴结转移规律与规范化治疗研究  

Lymph node metastasis rule and standardized treatment of esophagogastric junction adenocarcinoma

作　　者：王作培[1] 韦海涛[1] 张锋[1] 何占锋[1] 张海峰[1] 胡宝利[1] 

机构地区：[1]河南大学淮河医院胸外科二病区,开封475000

出　　处：《中国药物与临床》2015年第7期930-932,共3页Chinese Remedies & Clinics

摘　　要：目的探讨食管胃交界区腺癌的淋巴结转移的规律特点,比较分析不同手术方式清扫纵隔及腹腔淋巴结情况。方法收集2007年1月至2010年2月河南大学淮河医院胸外科(包括经左胸及Ivor Lewis两种术式)和胃肠外科(经上腹)收治的Ⅱ型食管胃交界区腺癌共98例,按手术方式分成经左胸,经上腹以及Ivor Lewis 3组,分析3组病例下纵隔淋巴结和腹腔淋巴结的清扫率以及转移率,总结其转移规律。结果经左胸、经上腹以及Ivor Lewis 3种术式,对于下纵隔淋巴结包括隆突下淋巴结,食管旁淋巴结,下肺静脉旁淋巴结以及肺门淋巴结的清扫率差异都有统计学意义(P<0.05);经左胸及Ivor Lewis清扫下纵隔淋巴结要优于经上腹术式;对于腹内淋巴结,除贲门旁淋巴结3种手术方式清扫率无明显差异外,对于胃左动脉旁淋巴结,肝总动脉旁淋巴结,脾动脉淋巴结以及腹腔淋巴结4组淋巴结,经腹清扫(上腹组或Ivor Lewis组)要明显优于单纯经左胸术式;经左胸、经上腹以及Ivor Lewis 3种术式,下纵隔淋巴结以及腹腔淋巴结转移率差异均无统计学意义(P>0.05)。结论 Ivor Lewis术式则同时具备经胸和经腹的优点,可以保证最大程度完整切除肿瘤和做到真正的二野淋巴结清扫,是一种应该提倡的手术方式。Objective To investigate the characteristics of lymph node metastasis of esophagogastric junction（EGJ） adenocarcinoma, and to compare the effects of different surgical procedures on mediastinal and celiac lymph nodes dissection. Methods Ninety-eight patients with type Ⅱ EGJ adenocarcinoma hospitalized in Department of Chest Surgery（underwent left thoracotomy and Ivor Lewis surgery） and Department of Gastrointestinal Surgery（under-went upper laparotomy）, Huaihe Hospital of Henan University between January 2007 and February 2010 were includ-ed as the subjects in the study. All patients were divided into 3 groups according to different surgical procedures of left thoracotomy, upper laparotomy and Ivor Lewis surgery. The dissection rate and metastasis rate of lower mediasti-nal and upper lymph nodes of the three groups were analyzed, and the metastasis rule was summarized. Results There were statistically significant differences in dissection rate of lower mediastinal lymph node, including subcarinal lymph node, paraesophageal lymph node, inferior pulmonary vein lymph node, and pulmonary hilar lymph nodes, be-tween the three surgical procedures of left thoracotomy, upper laparotomy and Ivor Lewis surgery（ P〈0.05）. The dissection rate of left thoracotomy and Ivor Lewis surgery was better than that of upper laparotomy. No significant differences were found in dissection rate between the three surgical procedures of intra-abdominal lymph node and cardia lymph node. For the left gastric artery lymph node, the common liver lymph node, spleen artery lymph node and celiac lymph node, the effects of abdominal dissection（in the upper abdomen group or the Ivor Lewis group） were signifi-cantly better than those of simple left thoracic procedure. There were no statistically significant differences in the metastasis rates of the lower mediastinal lymph node and celiac lymph node between left thoracotomy, upper laparoto-my and Ivor Lewis surgery（P〉0.05）. Conclusion The surgical procedure of Ivor Lewis

关 键 词：淋巴结切除术 食管胃交界区腺癌 手术径路 

分 类 号：R735[医药卫生—肿瘤]