《食管癌根治术胸部淋巴结清扫中国专家共识（2017版）》解读  

The interpretation of the Chinese expert consensus on mediastinal lymph node dissection in esophagectomy for esophageal cancer （2017 edition）

作　　者：叶鑫[1] 赵彦[1] 游宾[1] 李辉[1] Ye Xin;Zhao Yah;You Bin;Li Hui(Department of Thoracic Surgery,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院胸外科,100020

出　　处：《中华胃肠外科杂志》2018年第9期976-982,共7页Chinese Journal of Gastrointestinal Surgery

摘　　要：目前，国际上对食管癌胸部淋巴结分组及清扫标准仍未达成共识，其清扫指征、入路、数目及范围仍是学术界争论的焦点。为此，中国抗癌协会食管癌专业委员会组织行业内专家，基于临来经验和现有的循证医学证据，撰写了《食管癌根治术胸部淋巴结清扫中国专家共识（2017叛）》。本文针对共识中食管癌手术入路和喉返神经旁淋巴结清扫问题进行解读。由于右胸入路手术切除率相对较高，且在淋巴结清扫站数和数量上具有优势，因此，笔者推荐将右胸入路作为食管癌的一种主流术式在临床实践中广泛应用；但左胸径路尚不应被淘汰．临床也可以谨慎地应用于一些高选择性的患者。由于双侧喉返神经淋巴结在胸段食管癌的转移发生率很高，被列为胸部第1、2组淋巴结，故笔者强烈推荐．对所有食管癌患者进行双侧喉返神经淋巴结清扫：清扫方式可采用右胸入路行选择性三野清扫或“两野半”清扫．即双侧喉退神经旁淋巴结必须清扫，在此基础上对是否进行颈部清扫做出精确的选择。At present, there is still no general consensus on the thoracic lymph node classification and dissection standard of esophageal cancer, and its indications, surgical approaches, harvested number and scopes are still the debated tocuses in the academic circle. Therefore, the Society of Esophageal Tumor, Chinese Anti-Cancer Association organized experts in the field to write the Chinese expert consensus on mediastinal lymph node dissection in esophagectomy for esophageal cancer （2017 edition） based on clinical experience and current available evidence. This article focuses on the surgical approach and recurrent laryngeal nerve lymph node dissection in esophageal cancer. The right thoracic approach is recommended for wide application in clinical practice by the authors because of the high resection rate and the advantages of more stations and higher number. But the left thoracic approach should not be eliminated and can be used cautiously to some particular patient. Because the metastatic rate of bilateral recurrent laryngeal nerve lymph node in thoracic esophageal cancer is very high, it is classified as the first and the second group of thoracic lymph nodes. Hence, the authors strnngly recommend that bilateral recurrent laryngeal nerve lymph node dissection should be performed for all the esophageal cancer patients. The 3-field or 2 and a half field dissection can be performed by right thoracic approaeh. The bilateral recurrent laryngeal nerve lymph nodes must be cleaned, and the decision of neck dissection should be made accordingly.

关 键 词：食管肿瘤 喉返神经 淋巴结清扫 共识 

分 类 号：R735.1[医药卫生—肿瘤]