二野与三野淋巴结清扫术在食管癌根治术中的短期疗效及远期预后的meta分析  

Meta-analysis of short-term efficacy and long-term prognosis of two-field and three-field lymphadenectomy in radical resection of esophageal cancer

作　　者：李少杰 金悦 孙清超[1] 李德生[1] 张力为[1] LI Shaojie;JIN Yue;SUN Qingchao;LI Desheng;ZHANG Liwei(Department of Thoracic Surgery,the First Affiliated Hospital of Xinjiang Medical University,Xinjiang,Urumqi 830054,China)

机构地区：[1]新疆医科大学第一附属医院胸外科,新疆乌鲁木齐830054

出　　处：《中国医药科学》2025年第4期85-89,143,共6页China Medicine And Pharmacy

基　　金：省部共建中亚高发病成因与防治国家重点实验室开放课题资助项目(SKL-HIDCA-2020-SG3)。

摘　　要：目的探讨二野淋巴结清扫术(2-FL)与三野淋巴结清扫术(3-FL)在食管癌患者中的疗效及预后。方法检索中国知网、万方数据库、维普、Web of Science、Cochrane library、PubMed等,收集2-FL与3-FL运用在食管癌根治术中的随机对照试验(RCT)及倾向性评分匹配研究(PSM),检索时限为自建库至2023年12月,对符合纳入标准的文献行数据提取和质量评价后行meta分析。结果共纳入10篇文献,包括6篇RCT,4篇PSM。共纳入2180例研究对象。meta分析结果显示,3-FL组较2-FL组手术时间长,差异有统计学意义(P<0.05),但术中出血量差异无统计学意义(P>0.05)。3-FL组淋巴结清扫数量及获得阳性淋巴结数量多于2-FL组,差异有统计学意义(P<0.05)。在术后心脏并发症、呼吸系统并发症、乳糜胸、吻合口瘘、喉返神经损伤方面,3-FL组与2-FL组差异无统计学意义(P>0.05)。两组生存率和无病生存期差异无统计学意义(P>0.05)。结论在食管癌患者中行3-FL术后生存率与2-FL相当,不会增加术后并发症,且3-FL可获得更多阳性淋巴结,可以提高肿瘤分期的准确性,值得临床推广应用。Objective To investigate the therapeutic efficacy and prognosis of two-field lymphadenectomy(2-FL)and three-field lymphadenectomy(3-FL)in patients with esophageal cancer.Methods China National Knowledge Infrastructure(CNKI),Wanfang Database,VIP Database,Web of Science,Cochrane library,PubMed,etc.were searched by computer.The randomized controlled trial(RCT)and propensity score matching(PSM)of 2-FL and 3-FL in radical resection of esophageal cancer were collected.The retrieval time was from the establishment of database to December 2023,and meta-analysis was made after literature line data extraction and quality evaluation of those that met the inclusion criteria.Results A total of 10 articles were included,including 6 RCT articles and 4 PSM articles.A total of 2180 subjects were included.The meta results showed that the operation time in the 3-FL group was longer than that in the 2-FL group,with statistically significant difference(P<0.05),but there was no statistically significant difference in the intraoperative hemorrhage volume(P>0.05).The numbers of lymph node dissection and positive lymph nodes in the 3-FL group were more than those in the 2-FL group,with statistically significant differences(P<0.05).There were no statistically significant differences between the 3-FL group and the 2-FL group in postoperative cardiac complications,respiratory complications,chylothorax,anastomotic leakage and recurrent laryngeal nerve injury(P>0.05).There were no statistically significant differences in survival rate and disease-free survival between the two groups(P>0.05).Conclusion In patients with esophageal cancer,the postoperative survival rate of the 3-FL group is similar to that of the 2-FL group,which will not increase postoperative complications,and the 3-FL group can obtain more positive lymph nodes,which can improve the accuracy of tumor staging and is worthy of clinical promotion and application.

关 键 词：食管癌 二野淋巴结清扫术 三野淋巴结清扫术 并发症 预后 

分 类 号：R735.1[医药卫生—肿瘤]