食管癌术中清扫隆突下淋巴结的价值  

Significance of subcarinal lymph node dissection in patients undergoing esophageal cancer surgery

作　　者：刘郁鹏[1] 施民新[1] 樊怿辉[1] 陈赛华[1] 谢鹏飞[1] 周晓梅[2] 毛清华[1] 

机构地区：[1]南通肿瘤医院胸外科,江苏省226361 [2]南通肿瘤医院护理部,江苏省226361

出　　处：《江苏医药》2015年第21期2571-2573,共3页Jiangsu Medical Journal

摘　　要：目的探讨食管癌术中清扫直径<1.5cm隆突下淋巴结的价值。方法原发性食管鳞状细胞癌患者115例,术前胸部增强CT均提示隆突下淋巴结肿大<1.5cm。术中,58例行隆突下淋巴结清扫(A组),57例仅行隆突下淋巴结活检(B组),病理提示无转移。比较两组术后肺部并发症发生情况,并回顾1000例原发性食管上皮鳞状细胞癌患者的病理资料。结果 1000例原发性食管上皮鳞状细胞癌患者中,术后病理报告隆突下淋巴结转移率为4.4%(44/1000);其中,肿大隆突下淋巴结<1.5cm者的肿瘤转移率仅为0.7%(5/751)。A组术后出现刺激性咳嗽发生率为37.9%(22/58),肺部感染发生率为17.2%(10/58),高于B组的14.0%(8/57)(P<0.01)和5.3%(3/57)(P<0.05)。结论对于隆突下淋巴结肿大<1.5cm的原发性食管鳞状细胞癌患者,因其低转移率可有选择性的进行清扫,以减少对周围神经和血管的损伤,降低术后肺部并发症的发生。Objective To investigate the significance of dissection of subcarinal lymph node1.5cm in diameter in patients undergoing esophageal cancer surgery.Methods The subcarinal lymph nodes〈1.5cm in diameter were showed by enhanced CT in 115 patients with primary esophageal squamous cell carcinoma.The dissection of subcarinal lymph nodes 〈1.5cm in diameter was performed in 58cases（group A）.Biopsy was performed in another 57cases（group B）,which showed a tumor metastasis negative.Postoperative pulmonary complications were compared between two groups.Postoperative pathological data of 1000 cases with primary esophageal squamous cell carcinoma were retrospectively analyzed.Results The subcarinal lymph node metastasis rate was4.4%（44/1000）,which was only 0.7%（5/751）in the cases with subcarinal lymph nodes〈1.5cm in diameter.The incidence rate of postoperative irritating cough in group A was 37.9%（22/58）and that of pulmonary infection was 17.2%（10/58）,which were higher than 14.0%（8/57）（P〈0.01）and5.3%（3/57）in group B（P〈0.05）.Conclusion Considering the low metastasis rate of the subcarinal lymph nodes1.5cm in diameter in the patients with primary esophageal squamous cell carcinoma,dissection of the subcarinal lymph nodes might be performed selectively to decrease the postoperative pulmonary complications by reducing the injury of peripheral nerve and blood vessel.

关 键 词：食管癌 隆突下淋巴结 肺部并发症 

分 类 号：R735[医药卫生—肿瘤]