| 胸中段食管癌胸腹二野淋巴结清扫及其转移规律的临床研究 |
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| 引用本文： | 田界勇,马冬春,魏大中,徐美青,范军,朱晓枫,郭明发,戎保林,柯立,梅新宇,徐世斌,王君.胸中段食管癌胸腹二野淋巴结清扫及其转移规律的临床研究[J].中国肿瘤临床,2010,37(14):831-833. |
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| 作者姓名： | 田界勇 马冬春 魏大中 徐美青 范军 朱晓枫 郭明发 戎保林 柯立 梅新宇 徐世斌 王君 |
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| 作者单位： | 作者单位:安徽医科大学附属省立医院胸外科(合肥市230001) |
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| 摘 要： | 目的:探讨胸中段食管癌胸腹二野淋巴结转移规律及其清扫方法，指导临床淋巴结清扫的范围。方法:对95例胸中段食管癌采用右胸及上腹正中两切口术式为基础进行胸腹二野淋巴结清扫，并对淋巴结转移规律进行分析。结果:95例胸中段食管患者淋巴结转移度为20.4% ，肿瘤浸润深度和分化程度对淋巴结转移率的影响具有统计学意义。胸中段食管癌既有向上到右颈气管旁、双侧喉返神经链旁、食管旁、癌肿旁、隆突下淋巴结转移，也有向下至贲门旁、胃左动脉旁、胃小弯网膜等处淋巴结转移，呈现双向转移趋势。结论:胸中段食管癌患者淋巴结转移与肿瘤浸润深度及分化程度明显相关。具有胸腹二野淋巴结转移的倾向，右颈气管旁及双侧喉返神经链是淋巴结转移重要区域，右胸及上腹两切口术式更方便胸中段食管癌切除和胸腹二野淋巴结的清扫，并且以此为基础经右胸顶对右颈气管旁及双侧喉返神经链淋巴结清扫也是安全可行的。
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| 关 键 词： | 胸中段食管癌 淋巴结转移 二野淋巴结清扫 |
| 收稿时间： | 2009-10-28 |
Clinical Research on Thoraco-abdominal Two-field Lymph Node Dissection and Regularity of Metastasis in Middle-third Thoracic Esophageal Carcinoma |
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| TIAN Jieyong,MA Dongchun,WEI Dazhong,XU Meiqing,FAN Jun,ZHU Xiaofeng,GUO Mingfa,RONG Baolin,KE Li,MEI Xinyu,XU Shibin,WANG Jun.Clinical Research on Thoraco-abdominal Two-field Lymph Node Dissection and Regularity of Metastasis in Middle-third Thoracic Esophageal Carcinoma[J].Chinese Journal of Clinical Oncology,2010,37(14):831-833. |
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| Authors: | TIAN Jieyong MA Dongchun WEI Dazhong XU Meiqing FAN Jun ZHU Xiaofeng GUO Mingfa RONG Baolin KE Li MEI Xinyu XU Shibin WANG Jun |
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| Affiliation: | Department of Thoracic Surgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei 230001, China |
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| Abstract: | Objective: To investigate the regularity of thoraco-abdominal two-field lymphatic metastasis and method of the nodal dissection in middle-third thoracic esophageal carcinoma, and to guide the scope of the lymph-node clearance. Methods:Thoraco-abdominal two-field lymph-node dissection based on surgical incisions of the right chest and middle up-per abdomen were conducted in 95cases with middle-third thoracic esophageal cancer and the regularity of nodal metasta-sis was analyzed. Results:The nodal metastasis ratio of the 95patients was 20.4%. The infiltration depth and differentiation of the tumor is of statistical significance on the nodal metastasis ratio. The middle-third thoracic esophageal cancer not only includes the nodal metastases up to the trachea of the right neck, around the bilateral recurrent laryngeal nerve chains, near the esophagus and the tumor, and the lymph-node metastasis at the inferior tracheal protuberance, but also the nodal metastases down to the cardia, around the left gastric artery and at the retina of the lesser curvature of the stomach etc., presenting a tendency of 2-way metastasis. Conclusion:The lymph node metastasis of patients with middle-third thoracic esophageal carcinoma was significantly correlated with the depth of tumor invasion and the degree of differentiation, with the tendency of thoraco-abdominal 2-field nodal metastasis. The peri-tracheal lymph node at right neck and bilateral recur-rent laryngeal nerve chains are important regions of the metastasis. The surgical incision of the right thorax and upper ab -domen greatly facilitates the excision of the middle-third thoracic esophageal cancer and the2-field lymph node dissection. Thus on this basis, the lymph node clearance around the right trachea and at bilateral recurrent laryngeal nerve chains through the right thoracic apex is safe and feasible. |
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