早期食管癌淋巴结转移特点及临床意义

目的　探讨早期食管癌的淋巴结转移特点及临床意义。方法　对内镜检查诊断考虑为早期食管癌的患者经上腹、右胸二切或加行左颈三切口 ,行标准胸、腹二区域淋巴结清扫食管癌根治术。对不同区域的淋巴结编号进行病理检查。术后进行 5年生存率的调查。结果　经术后病理证实为早期食管癌 2 2 4例。总淋巴结转移率为 10 .2 7%,转移度 4.0 1%。不同的病灶部位对早期食管癌淋巴结转移率差异无显著性 (P >0 .0 5 )。不同的肉眼分型间淋巴结转移率差异有高度显著性 (P <0 .0 1)。原位癌和侵犯粘膜下层癌淋巴结转移率分别为 4.0 8%和 14 .0 7%,差异显著 (P <0 .0 5 )。病灶范围大小对淋巴结转移率的影响差异不显著 (P >0 .0 5 )。鳞癌和癌肉瘤淋巴结转移率分别为 10 .0 %和 2 5 .0 %(P <0 .0 1) .术后总 5年生存率 94.5 4%,无淋巴结转者 96.97%,有淋巴结转移者 72 .2 2 %,一区域淋巴结转移 5年生存率 81.18%,二区域淋巴结转移 5年生存率 5 7.14 %。有无淋巴结转移及淋巴结转移范围大小对 5年生存率的影响差异有高度显著性 (P <0 .0 1)。结论　早期食管癌淋巴结转移发生率比较高。早期食管癌的肉眼分型、浸润深度、组织学分型是影响其淋巴结转移的重要因子。淋巴结转移是影响早期食管癌 5年生存率的重要因素。

The Characterization and the Clinical Significance of Lymph Node Metastases of Early Esophageal Carcinoma

Objective To study the characterization and the clinical significance of the lymph node metastases of early esophageal carcinoma.Methods The standard Iover-lewis esophagogastrectomy was performed in the small superficial esophageal carcinoma detected by means of endoscopic examination from 1985 to 2002.Our indications of left cervical dissection were the cases of upper thoracic cancer.The pathological examination was performed for different regions of lymph nodes respectively.The investigation of survival rate was performed.Results A total of 224 patients was identified to early esophageal carcinoma by postoperatively pathological examination.The overall lymph node metastatic (LNM) rate was 10.27%.While the degree of LNM was 4.01% in all fields.The significant differences had not been obtained among the rates,of LNM in different esophageal segments ( P > 0.05 ).The rates of LNM in patients with squamous carcinoma and sarcocarcinoma were 10.0% and 25.0% respectively ( P < 0.001 ).The frequency of positive nodes was 4.08% in esophageal intraepithelial carcinoma,14.07%in the submucosal layer cancer( P =0.021).The macroscopic pattern showed significant difference( P <0.001).The overall 5-year survival rate was 94.54%.It was 96.97% in patients without LNM,72.22% in those with LNM,81.18% in those LNM to one region and 57.14% in these LNM to two ( P <0.001).Conclusions The positive lymph node in early easophageal carcinoma showed high frequency.The macroscopic pattern,invasion depth and histological pattern of tumor are major factors affecting LNM of esophageal carcinoma.The LNM is an important prognostic factor of early esophageal carcinoma.