胸段食管鳞癌淋巴结转移特点及危险因素分析  

Analysis of the lymphatic metastasis characteristics and risk factors for thoracic esophageal squamous cell carcinoma

作　　者：嵇建[1] 郭伟[1] 

机构地区：[1]南京医科大学附属淮安第一医院心胸外科,江苏淮安223300

出　　处：《西部医学》2015年第10期1565-1568,共4页Medical Journal of West China

摘　　要：目的探讨胸段食管鳞癌淋巴结转移规律以及相关影响因素。方法回顾性研究行三野淋巴结清扫的食管癌手术病例123例,通过单因素分析及多因素统计其临床病理资料与淋巴结转移的关系以及食管癌区域淋巴结转移的规律。结果食管旁、气管旁、隆突下为食管癌淋巴结转移的好发区域。单因素分析提示肿瘤长度、浸润程度、分化程度对淋巴结转移度的影响存在统计学差异(P<0.05)。多因素分析提示:肿瘤浸润程度为食管癌淋巴结转移的重要影响因素(P=0.006),其中T3、T4期较T1期患者出现淋巴结转移的风险分别增加了6.681和7.827倍;食管旁、气管旁淋巴结转移为隆突下淋巴结转移的危险因素,分别增加了6.896和5.277倍。结论胸上段食管癌容易出现颈部及气管旁淋巴结转移,术中应积极行颈部及中上纵隔区域淋巴结清扫;胸中段食管癌有上下双向淋巴结转移特点,术中建议行胸、腹淋巴结清扫;而胸下段食管癌有腹部及下纵隔的食管旁、隆突下转移的特点,可行中下纵隔及腹部区域淋巴结清扫。另外,因浸润程度越深,越易出现淋巴结转移,术中可根据肿瘤浸润情况,必要时行三野淋巴结清扫。Objective To explore the rules and related factors of the lymphatic metastasis of thoracic esophageal carcinoma.Methods We have collected the clinical and pathological data of 123 cases from January 2013 to March 2014 underwent in three-field lymph node dissection for esophageal cancer,and through single factor analysis and multi factor analysis statistical methods analyzed the clinical and pathological data relationship with lymphatic metastasis and esophageal cancer with regional lymph node metastasis rule.Results The paraesophageal,paratracheal,subcarinal had a good area of lymphatic metastasis of esophageal cancer.Single factor analysis showed that the tumor length,degree of differentiation,infiltration degree of lymphatic metastasis were statistically significant（P 0.05）.Multivariate analysis showed that the depth of invasion had an important influence on the lymphatic metastasis of thoracic esophageal carcinoma（P=0.006）,and comparing in T1 stage,the risk of lymphatic metastasis of T3 and T4stage patients increased by6.681,7.827 times.Paraesophageal,paratracheal lymphatic metastasis were the risk factors to subcarinal lymphatic metastasis,increased by 6.896,5.277 times.Conclusion Upper thoracic esophageal cancer prone to neck and paratracheal lymphatic metastasis should be done in the neck and upper mediastinal lymph node dissection.Middle thoracic esophageal carcinoma with upper and lower two-way characteristics of lymph node metastasis,intraoperative suggestions for thoracic and abdominal lymph node dissection.And the lower thoracic esophageal carcinoma has the characteristics of abdominal and lower esophageal mediastinal side,subcarinal transfer,feasible lower mediastinal and abdominal lymph node dissection.In addition,the degree of infiltration is deeper,more prone to lymph node metastasis.During the operation,according to the tumor infiltration,We should clean up the lymph nodes in three-field when necessary.

关 键 词：食管癌 三野淋巴结清扫 淋巴结转移 

分 类 号：R73-77[医药卫生—肿瘤]