喉返神经旁淋巴结切除对T1N0M0期食管鳞状细胞癌患者预后及相关并发症的影响  

Effect of recurrent laryngeal lymph nodes resection on prognosis and surgical complications in patients with stage T1N0M0 esophageal squamous cell carcinoma

作　　者：胡山 赵波[1] 邓豫 李樊 HU Shan;ZHAO Bo;DENG Yu;LI Fan(Department of Thoracic Surgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,430030,P.R.China)

机构地区：[1]华中科技大学同济医学院附属同济医院胸外科,武汉430030

出　　处：《中国胸心血管外科临床杂志》2020年第5期525-529,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的对比术中进行不同方式喉返神经旁淋巴结切除的患者喉返神经损伤相关并发症和预后情况,以评估喉返神经旁淋巴结切除的安全性和必要性。方法回顾性分析2014年6月至2016年5月于华中科技大学同济医学院附属同济医院胸外科行食管癌根治术的153例T1N0M0期食管鳞状细胞癌(鳞癌)患者的临床资料,其中男125例、女28例,平均年龄62岁。所有患者都进行了双侧喉返神经旁淋巴结采样。根据淋巴结切除情况,将患者分为3组:术中切除双侧喉返神经旁淋巴结各1枚的患者作为采样组(49例);一侧喉返神经旁淋巴结切除1枚,另一侧喉返神经旁淋巴结切除数量>1枚的患者作为单侧清扫组(49例);双侧喉返神经旁淋巴结切除数量都>1枚的患者作为双侧清扫组(55例)。术后随访,比较各组患者之间预后的差异。术后7 d使用电子喉镜检查患者声带情况并采用Clavien-Dindo系统进行分级。比较各组患者之间出现喉返神经损伤相关并发症的差异。结果采样组患者5年总生存期(OS)率为66.8%,单侧清扫组88.5%,双侧清扫组93.8%;采样组与单侧清扫组或双侧清扫组之间5年OS率差异有统计学意义(P<0.05),单侧清扫组与双侧清扫组之间差异无统计学意义(P>0.05)。各组之间并发症发生率差异无统计学意义(P>0.05)。结论对于T1N0M0期的食管鳞癌患者,术中对双侧喉返神经旁淋巴结应尽可能清扫,有利于提高患者术后5年生存率。Objective To evaluate the safety and necessity of recurrent laryngeal lymph node resection by comparing the complications and prognosis of patients with recurrent laryngeal nerve injury receiving different recurrent laryngeal lymph node resections.Methods We reviewed the clinical data of 153 patients with stage T1N0M0 esophageal squamous cell carcinoma who underwent radical esophageal cancer surgery at the Department of Thoracic Surgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology from June 2014 to May 2016.Among them,125 were male and 28 were female,at an average age of 62 years.All patients underwent bilateral recurrent laryngeal nodes sampling.They were divided into 3 groups according to the dissection situation:patients with only one recurrent laryngeal lymph node resection on both sides during the operation were treated as a sampling group(n=49);patients with only one recurrent laryngeal lymph node resection on one side and more than one recurrent laryngeal lymph nodes resection on the other side were treated as a unilateral dissection group(n=49);patients with more than one recurrent laryngeal lymph nodes resection on both sides were treated as a bilateral dissection group(n=55).Follow-up was performed to compare the prognostic differences among the three groups.Seven days after the operation,the vocal cords of the patients were examined with an electronic laryngoscope and classified using the Clavien-Dindo system.The differences in complications related to recurrent laryngeal nerve injury among the three groups were compared.Results The 5-year overall survival(OS)rate of the patients in the sampling group,unilateral dissection group and bilateral dissection group was 66.8%,88.5%,93.8%,respectively.There was statistical difference between the sampling group and the unilateral dissection group or the bilateral dissection group(P<0.05),and no statistical difference between the unilateral dissection group and the bilateral dissection group(P>0.05).The incidence of compli

关 键 词：食管鳞状细胞癌 淋巴结 喉返神经 并发症 外科手术 治疗 

分 类 号：R735.1[医药卫生—肿瘤]