早期食管癌患者微创喉返神经旁淋巴结清扫术的临床应用及预后影响因素分析  

The clinical application and prognostic factors of minimally invasive lymphadenectomy for patients with early esophageal cancer

作　　者：张广敬[1] 姜美玲[1] 张康[1] 裴宝祥[1] 杨满琪 徐军[1] ZHANG Guangjing;JIANG Meiling;ZHANG Kang;PEI Baoxiang;YANG Manqi;XU Jun(Department of Thoracic Surgery,Jining First People's Hospital,Shandong Jining 272001,China.)

机构地区：[1]济宁市第一人民医院胸外科,山东济宁272001

出　　处：《现代肿瘤医学》2021年第16期2806-2811,共6页Journal of Modern Oncology

基　　金：山东省济宁市科技支持项目(编号:2017SMNS009)。

摘　　要：目的:探讨微创喉返神经旁淋巴结清扫术对早期食管癌患者的临床应用价值及预后影响。方法:收集2014年6月-2018年5月济宁市第一人民医院胸外科行食管癌淋巴结清扫患者242例的临床资料,对符合条件的102例早期食管癌患者进行回顾性分析。依据喉返神经旁淋巴结清扫方式,分为微创组(IG,n=66)和常规组(NG,n=36),比较两组患者切除淋巴结的临床特征。采用二元Logistics回归分析影响早期食管癌患者预后存活率的相关因素。结果:两组患者在既往开胸史、切入深度、甲状腺动脉参数和半定量评分、淋巴结清扫数目、喉返处淋巴结被膜残留个数、术后恢复时间、APACHEII评分,存在显著差异(P均<0.05),而年龄、存在转移淋巴结个数、腹、胸腔处淋巴结被膜残留个数,以及并发症出现率,无显著差异(P均>0.05)。对2年内预后生存进行单因素分析,发现存在9个显著差异因素,分别为年龄、既往开胸、喉返处淋巴结切入深度、手术方式、淋巴结转移个数、喉返神经旁淋巴结切除数目(左、右和总数)和被膜残留个数,以及APACHEII评分和并发症出现率。经多因素Cox比例风险回归分析,发现其中7个因素与预后生存结局密切相关,且为独立危险因素。结论:微创术能完整地清扫喉返神经旁可疑或病变的淋巴结,通过提高准确判断病灶位置,控制切入深度,减少对周围血管和组织的破坏,降低肿瘤的转移和并发症出现风险,延长食管癌患者预后存活时间。Objective:To explore the clinical application value and prognostic effect of different lymphadenectomy for patients with early esophageal cancer.Methods:From June 2014 to May 2018,clinical data of 242 patients with esophageal cancer who underwent lymph node dissection in thoracic surgery of the First People's Hospital of Jining were collected and 102 patients with early esophageal cancer who met the conditions were analyzed retrospectively.According to the way of lymphadenectomy,the patients were divided into minimally invasive group(n=66)and conventional group(n=36),and the clinical characteristics of lymphadenectomy in the two groups were compared.Binary Logistic regression analysis was used to analyze the factors influencing the prognosis and survival rate of patients with early esophageal cancer.Results:There were significant differences between the two groups in the past history,depth of incision,thyroid artery parameters and semi quantitative score,number of lymph node dissection,the number of residual laryngeal lymph node membrane,postoperative recovery time,APACHEII score(all P<0.05),but there were no significant differences in age,number of metastatic lymph nodes,number of residual abdominal and thoracic lymph node membrane,and the incidence of complications The difference(all P>0.05).The single factor analysis of prognosis and survival in 2 years showed that there were 9 significant difference factors,including age,past history,depth of laryngeal recurrent lymph node,operation method,the number of lymph node metastasis,and the number of paratracheal lymph node resection(left,right and total),number of membrane residue,APACHEII score and incidence of complications.By multivariate Cox proportional risk regression analysis,it was found that 7 factors were closely related to prognosis and survival outcome,and were independent risk factors.Conclusion:Microsurgery can completely clean lymph nodes with suspicious or pathological changes near the recurrent laryngeal nerve,and reduce the damage to peripheral blo

关 键 词：食管癌 微创术 喉返神经旁 淋巴结清扫 生存率 预后 

分 类 号：R735.1[医药卫生—肿瘤]