SiewertⅡ型食管胃结合部腺癌侵犯食管胃结合部黏膜下不同静脉分区对下纵隔和食管裂孔淋巴结转移的影响  

Influencing of inferior mediastinum and esophageal hiatus lymph node metastasis in Siewert type I adenocarcinoma of esophagogastric junction invading submucosal different venous divisions ofesophagogastric

作　　者：马海霞 张勇 张卫国[2] 张双平 任一鹏 陶凯 Ma Haixia;Zhang Yong;Zhang Weiguo;Zhang Shuangping;Ren Yipeng;Tao Kai(Department of Pathology,Hepatobiliary and Pancreatic,Gastric Surgery,Shanxi Hospital of Cancer Hospital Chinese Academy of Medical Science,Shanxi Cancer Hospital,Taiyuan 030013,China;Depart-ment of Anatomy,Shanxi Medical University,Taiyuan 030013,China)

机构地区：[1]中国医学科学院肿瘤医院山西医院、山西省肿瘤医院病理科、肝胆胰胃外科,太原030013 [2]山西医科大学解剖教研室,太原030013

出　　处：《中华消化外科杂志》2023年第3期391-398,共8页Chinese Journal of Digestive Surgery

基　　金：山西省重点研发计划社发项目(201803D31167);山西省肿瘤医院创新团队建设项目(2020009)。

摘　　要：目的探讨SiewertⅡ型食管胃结合部腺癌(AEG)侵犯食管胃结合部(EGJ)黏膜下不同静脉分区对下纵隔和食管裂孔淋巴结转移的影响。方法采用回顾性病例对照研究方法。收集2018年1月至2021年12月山西省肿瘤医院收治的547例SiewertⅡ型AEG患者的临床病理资料;男461例,女86例;年龄为61(33~75)岁。观察指标:(1)各组淋巴结转移率。(2)影响SiewertⅡ型AEG患者发生下纵隔淋巴结转移的因素分析。(3)影响SiewertⅡ型AEG患者发生食管裂孔淋巴结转移的因素分析。正态分布的计量资料以x±s表示,组间比较采用t检验。偏态分布的计量资料以M(范围)或M(Q1,Q3)表示,组间比较采用Mann-WhitneyU检验。计数资料以百分比或绝对数表示,组间比较采用χ2检验。单因素分析根据资料类型选择对应的统计学方法。多因素分析采用Logistic回归模型。结果(1)各组淋巴结转移率。547例患者No.1、2、3、4sa、4sb、7、8a、9、11、20、108、110组淋巴结转移率分别为17.37%(95/547)、6.76%(37/547)、46.44%(254/547)、1.65%(9/547)、1.10%(6/547)、23.22%(127/547)、4.39%(24/547)、3.11%(17/547)、3.47%(19/547)、3.66%(20/547)、0.55%(3/547)、4.20%(23/547)。547例患者中,456例肿瘤近端侵犯EGJ黏膜栅状区,发生下纵隔淋巴结转移4例,无中纵隔和上纵隔淋巴结转移;91例肿瘤近端侵犯EGJ黏膜穿支区,发生下纵隔淋巴结转移18例、中纵隔淋巴结转移3例、无上纵隔淋巴结转移。(2)影响SiewertⅡ型AEG患者发生下纵隔淋巴结转移的因素分析。多因素分析结果显示:年龄、EGJ黏膜穿支区受侵犯、组织分级是SiewertⅡ型AEG患者发生下纵隔淋巴结转移的独立影响因素(比值比=0.93,23.33,0.31,95%可信区间为0.87~0.99,4.18~130.28,0.12~0.78,P<0.05)。(3)影响SiewertⅡ型AEG患者发生食管裂孔淋巴结转移的因素分析。多因素分析结果显示:EGJ黏膜穿支区受侵犯是SiewertⅡ型AEG患者发生食管裂孔淋巴结转移的独Objective To investigate the influencing of inferior mediastinum and esophageal hiatus lymph node metastasis by submucosal different venous divisions of esophagogastric junction(EGJ)invaded in Siewert typeⅡadenocarcinoma of esophagogastric junction(AEG).Methods The retrospective case-control study was conducted.The clinicopathological data of 547 patients with Siewert typeⅡAEG who were admitted to Shanxi Cancer Hospital from January 2018 to December 2021 were collected.There were 461 males and 86 females,aged 61(range,33-75)years.Observa-tion indicators:(1)lymph node metastasis rate in different groups;(2)influencing factors of inferior mediastinum lymph node metastasis in Siewert typeⅡAEG;(3)influencing factors of esophageal hiatus lymph node metastasis in Siewert typeⅡAEG.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was conducted using the t test.Measurement data with skewed distribution were represented as M(range)or M(Q1,Q3),and com-parison between groups was conducted using the Mann-Whitney U test.Count data were described as percentages or absolute numbers,and comparison between groups was conducted using the chi-square test.The univariate analysis was conducted using the corresponding statistical methods based on data type.The Logistic regression model was used for multivariate analysis.Results(1)Lymph node metastasis rate in different groups.The lymph node metastasis rate in No.1,2,3,4sa,4sb,7,8a,9,11,20,108,110 of the 547 patients was 17.37%(95/547),6.76%(37/547),46.44%(254/547),1.65%(9/547),1.10%(6/547),23.22%(127/547),4.39%(24/547),3.11%(17/547),3.47%(19/547),3.66%(20/547),0.55%(3/547),4.20%(23/547),respectively.Of the 547 patients,there were 456 cases with proximal of AEG invading submucosal palisade venous of EGJ including 4 cases with inferior mediastinum lymph node metastasis and no case with media mediastinum or up media-stinum lymph node metastasis.There were 91 cases with proximal of AEG invading submucosal perforator venous of EGJ

关 键 词：胃肿瘤 食管胃结合部 腺癌 SiewertⅡ型 淋巴结转移 静脉分区 

分 类 号：R735[医药卫生—肿瘤]