病理T1b期食管鳞状细胞癌外科治疗的结果分析  

Efficacy of surgical management for esophageal squamous cell carcinoma in pathological stage T1b

作　　者：朱多杰 王成[1] 魏小平[1] 杨建宝[1] 孟于琪[1] 宋铁牛[1] 张少博[1] 冯海明[1] 敬涛[1] 蒋鹏[1] 李斌[1] ZHU Duojie;WANG Cheng;WEI Xiaoping;YANG Jianbao;MENG Yuqi;SONG Tieniu;ZHANG Shaobo;FENG Haiming;JING Tao;JIANG Peng;LI Bin(Department of Thoracic Surgery,Lanzhou University Second Hospital,Lanzhou University Second Clinical Medical College,Lanzhou,730030,P.R.China)

机构地区：[1]兰州大学第二医院胸外科兰州大学第二临床医学院,兰州730030

出　　处：《中国胸心血管外科临床杂志》2021年第6期696-700,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：陇原青年创新创业人才(团队)项目。

摘　　要：目的探讨外科手术治疗病理T1b期食管鳞状细胞癌(鳞癌)的预后生存状况及预后影响因素。方法回顾性分析兰州大学第二医院2012~2015年接受经右胸路径食管癌根治性切除且术后病理为鳞癌T1b期95例患者的临床资料,其中男78例(78.3%)、女17例(21.7%),平均年龄(61.4±7.4)岁。结果 35例(36.8%)患者出现术后并发症,其中最常见的并发症为肺炎(15.8%),其次为吻合口瘘(12.6%)和心律失常(8.4%)。93例(97.9%)患者行R0切除,平均淋巴结清扫数量(14.4±5.6)枚。淋巴结转移率22.1%,淋巴脉管侵犯发生率为13.7%。中位随访时间60.4个月,其中25例患者死亡,27例患者出现复发。3年总体生存率86.3%,5年总体生存率72.7%。多因素Cox回归分析结果显示,淋巴结转移[P=0.012,HR=2.60,95%CI(1.23,5.50)]和淋巴管侵犯[P=0.014,HR=2.73,95%CI(1.22,6.09)]是影响pT1b期食管鳞癌总体生存率的独立危险因素。结论经右胸路径食管癌切除和胸腹两野淋巴结清扫对于病理T1b期食管鳞癌的治疗是安全可行的,且能够获得好的远期生存结果;淋巴结转移和淋巴管侵犯是影响病理T1b期食管鳞癌预后的独立危险因素。Objective To investigate the prognostic survival status and influence factors for surgical treatment of esophageal squamous cell carcinoma(ESCC)in pathological stage T1 b(pT1 b).Methods The patients with ESCC in pT1 b undergoing Ivor-Lewis or McKeown esophagectomy in Lanzhou University Second Hospital from 2012 to 2015 were collected,including 78 males(78.3%)and 17 females(21.7%)with an average age of 61.4±7.4 years.Results The most common postoperative complications were pneumonia(15.8%),anastomotic leakage(12.6%)and arrhythmia(8.4%).Ninety-three(97.9%)patients underwent R0 resection,with an average number of lymph node dissections of14.4±5.6.The rate of lymph node metastasis was 22.1%,and the incidence of lymph vessel invasion was 13.7%.The median follow-up time was 60.4 months,during which 25 patients died and 27 patients relapsed.The overall survival rate at 3 years was 86.3%,and at 5 years was 72.7%.Multivariate Cox regression analysis showed that lymph node metastasis(P=0.012,HR=2.60,95%CI 1.23-5.50)and lympovascular invasion(P=0.014,HR=2.73,95%CI 1.22-6.09)were independent risk factors for overall survival of pT1 b ESCC.Conclusion Esophagectomy via right chest approach combined with two-fields lymphadenectomy is safe and feasible for patients with pT1 b ESCC.The progress of pT1 b ESCC with lymph node metastasis or lymphovascular invasion is relatively poor.

关 键 词：食管鳞状细胞癌 病理T1b期 食管癌根治术 远期生存 外科手术 

分 类 号：R735.1[医药卫生—肿瘤]