术中胸内喉返神经旁淋巴结冰冻在指导胸段食管鳞癌三野淋巴结清扫的意义

目的 探讨胸段食管癌喉返神经旁淋巴结(RLN LN)与颈淋巴结的关系及其在选择性三野淋巴结清扫中的预测作用. 方法 选取100例食管胸段鳞癌为观察组,术中取胸内RLN LN送冰冻病理检查,若阳性,行颈、胸、腹三野淋巴结清扫;若阴性,则行胸、腹二野淋巴结清扫.收集患者的资料,分析RLN LN与颈部淋巴结之间的关系,并以100例行三野淋巴结清扫的食管癌患者为对照组.比较2组的手术并发症、颈部淋巴结复发率及近期生存率,以评估术中RLN LN冰冻的价值. 结果 当RLN LN转移时,颈部淋巴结转移率较高.多因素分析显示,RLN LN阳性是颈部淋巴结转移的独立预测因素,而且并不是所有的RLN LN都会导致同侧的锁骨上淋巴结转移.与对照组比较,观察组的手术并发症发生率较低,而颈部淋巴结复发及近期生存率2组间无明显差异.结论 RLN LN对颈部淋巴结转移有预测价值,特别是中下段食管癌患者.即使单侧的RLN LN转移,也应行双侧颈部淋巴结清扫.以RLN LN冰冻作为预测的选择性三野淋巴结清扫可降低手术并发症,近期疗效与三野淋巴结清扫相似,可使某些亚组患者获益.

Intraoperative Pathological Investigation of Recurrent NerveNodalmetastasis can Guide the Decision whether to PerformThree-Field Dissection in Thoracic Esophageal Cancer

Objective To evaluate the usefulness of intraoperative pathological investigation of recurrent laryngeal nerve lymph nodes(RLN LN) metastasis in the decision-making of three-field lymphadenectomy (3FL) for thoracic esophageal cancers.Methods 100 patients with thoracic esophageal cancer were enrolled in a prospective study,in which 3FL was performed when RLN LN metastasis was revealed by intraoperative histological examination.For cases with negative RLN LN,two-field lymphadenectomy (2FL) was performed.The relationship between the RLN LN and cervical lymph nodes(CLN)was analyzed by collecting patient data.We also retrospectively analyzed medical records of 100 patients with esophageal cancer who underwent 3FL in our department as control group,focusing on LN status.We compared the survival and recurrence rates of CLN between the test group and control group.Results The CLN metastasis rate was higher whenthe RLN LN was metastasized.Multivariate analysis showed that RLN LN positive was an independent predictor of CLN metastasis,and the RLN LN did not result in ipsilateral CLN metastasis.The short-termpostoperative survival in thetest group was equivalent to that of the control group of 100 3FL patients when 3FL was the firstchoice for thoracic esophageal cancers,with fewer surgical complications.There was no significant difference in CLN recurrence.ConclusionsIntraoperative histological diagnosis of RLN LN metastasis may help avoid unnecessary CLN resection.Bilateral CLN dissection should be recommended even if RLN LN metastasis is only unilateral.Selective 3FL can reduce the surgical complications and provideshort-termsurvival benefit like 3FL in certain patient subgroups.