胸中上段食管癌三野淋巴结清扫及二野淋巴结清扫临床疗效比较

目的：通过比较胸中上段食管癌三野淋巴结清扫及二野淋巴结清扫的结果，探讨胸中上段食管癌淋巴结清扫范围。方法：2008-2010年胸中上段食管癌手术治疗患者119例，接受三野淋巴结清扫术共46例（三野组），接受二野淋巴结清扫术共73例（二野组）。结果：三野组患者淋巴结转移率（58.7%）明显高于二野组（39.7%）（P<0.05），主要
差别在于三野组较高的颈部淋巴结转移率(21.7%)和较高的上纵隔淋巴结转移率，三野组与二野组患者上纵隔淋巴结转移率分别为28.2%和11.0%，组间比较差异有统计学意义（P<0.05）。三野组及二野组患者术后并发症发生率分别为39.1%和16.4%，组间比较差异有统计学意义（P<0.01），2组差别主要体现为三野组患者较高的喉返神经损伤发生率。三野组及二野组患者术后1年生存率分别为95.6%和83.5%，三野组显著高于二野组（P<0.01）。结论：与二野淋巴结清扫术比较，三野淋巴结清扫术能更彻底清扫颈部及上纵隔淋巴结，降低局部复发率，提高患者术后生存率，建议对排除远处转移的胸中上段食管癌患者行三野淋巴结清扫术。

Comparison of clinical efficacy between three-field lymphadenectomy and two-field lymphadenectomy in treatment of upper and middle thoracic esophageal cancer

Objective To explore the extent of lymph node dissection for upper and middle thoracic esophageal cancer by comparing the efficacy of three-field lymphadenectomy(3-FL) and two-field lymphadenectomy(2-FL).Methods 119 patients who were treated surgically with upper and middle thoracic esophageal squamous carcinoma from 2008 to 2010 were retrospectively reviewed.46 patients were treated by 3-FL(3-FL group),and the remain 73 patients were treated by 2-FL(2-FL group).Results The lymph node metastasis rate in 3-FL group(58.7%) was much higher than that in 2-FL group(39.7%),the difference was significant(P<0.05).The cervical lymph node metastasis rate in 3-FL group was 21.7%.The upper mediastinal lymph node metastasis rate in 3-FL group(28.2%) was much higher than that in 2-FL group(11.0%)(P<0.05).The surgical morbidity in 3-FL group(39.1%) was much higher than that in 2-FL group(16.4%,P<0.01),the main difference was the rate of recurrent laryngeal nerve palsy.The one-year survival rate of the patients in 3-FL group(95.6%) was higher than that in 2-FL group(83.5%)(P<0.01).Conclusion Compared with 2-FL,3-FL can dissect the cervical and upper mediastinal lymph nodes more thoroughly,reduce the local recurrence rate,and improve the rate of survival.The patients with upper and middle thoracic esophageal squamous carcinoma without metastasis should be operated by 3-FL.