313例胸段食管鳞癌患者的淋巴结转移特点  

Patterns of lymphatic spread in thoracic esophageal squamous cell carcinoma： a study of 313 cases

作　　者：李浩淼 李印 刘先本 孙海波 王总飞 郑燕 

机构地区：[1]郑州大学附属肿瘤医院胸外科,450003

出　　处：《中华肿瘤杂志》2015年第11期841-844,共4页Chinese Journal of Oncology

摘　　要：目的探讨胸段食管癌淋巴结转移的规律和特点，为食管癌淋巴结清扫范围和手术方式提供参考。方法回顾性分析2010年1月至2014年5月间收治的行胸腹腔镜联合食管癌根治术的313例胸段食管鳞癌患者临床资料，记录各组患者的淋巴结清扫及转移情况，并分析淋巴结转移的影响因素。结果313例患者中，有122例患者发生淋巴结转移，转移率为39．0％（122／313）；122例患者共清扫4461枚淋巴结，（14．3±6．2）枚／例，其中转移淋巴结294枚，淋巴结转移度为6．6％。在各组淋巴结中，喉返神经旁淋巴结的转移率为25．2％，贲门胃左动脉旁淋巴结的转移率为18．2％。单因素分析显示，肿瘤分化程度和T分期与食管鳞癌患者的淋巴结转移有关（均P〈0．001），其中肿瘤位置和分化程度与喉返神经旁淋巴结转移有关（均P〈0．05），肿瘤位置、分化程度和T分期与贲门胃左动脉旁淋巴结转移有关（均P〈0．05）。Logistic回归分析显示，肿瘤分化程度和肿瘤位置是影响喉返神经旁淋巴结转移的独立因素（均P〈0．05），肿瘤位置、分化程度和T分期是影响贲门胃左动脉旁淋巴结转移的独立因素（均P〈0．05）。结论胸段食管癌易发生喉返神经旁及贲门胃左动脉旁淋巴结转移；对于肿瘤分化程度低、浸润程度深的胸段食管癌患者，应进行广泛的淋巴结清扫。Objective We analyzed the lymph node （MLNs） metastasis of thoracic esophageal squamous cell carcinoma （ ESCC ） to explore the patterns of lymphatic spread and the rational surgical procedure and extent of lymph node dissection for ESCC. Methods We retrospectively evaluated 313 consecutive patients treated in our hospital between January 2010 and May 2014 who underwent minimally invasive esophagectomy （MIE） for ESCC. The information of lymph node status was obtained and the features of lymph node metastasis were analyzed. Results Of the 313 cases, 122 （39.0%） were found to have lymph node metastasis. In the 4461 dissected lymph nodes, metastasis was identified in 294 （6.6%） lymph nodes. The recurrent laryngeal nerve lymph nodes were the most frequent metastatic nodes with a metastasis rate of 25.2%, followed by the paracardiac and left gastric artery lymph nodes （18.2%）. Chi- square test showed that the lymph node metastasis is associated with tumor invasion and tumor differentiation （P〈0.001 for both）. Metastases were more frequently found in the recurrent laryngeal nerve lymph nodes in patients with tumors in the upper third esophagus and with histologically poor differentiation （P〈0.05 for both）. The metastasis rate of para-cardiac and left gastric artery lymph nodes was associated with tumor in the lower third of esophagus, T stage and differentiation （all P〈0.05）. Logistic regression analysis showed that tumor differentiation and location are independent factors affecting the metastasis of recurrent laryngeal nerve lymph nodes （P〈 0.05 for all）. T stage, tumor differentiation and location were independent factors associated with metastasis of para-cardiac and left gastric artery lymph nodes （P〈0.05 for all）. Conclusions （1） Metastases of thoracic esophageal carcinoma are often found in the recurrent laryngeal nerve lymph nodes, para-cardiac and left gastric artery lymph nodes. （2） Extensive lymph node dissection should be performed for ESCC with po

关 键 词：食管肿瘤 淋巴转移 外科手术 淋巴结切除术 

分 类 号：R735.1[医药卫生—肿瘤]