胸段食管癌淋巴结清扫范围的探讨

目的 探讨胸段食管癌下颈部淋巴结转移规律,评价合理的淋巴结清扫范围.方法 108例胸段食管癌患者术前应用彩色超声加CT对下颈部进行探查,有选择地分为三野淋巴结清扫(三野组)31例,二野淋巴结清扫(二野组)77例.结果 三野组手术死亡1例,术后并发症发生率41.9%(13131),高于二野组的18.2%(14/77)(P<0.05);胸上段食管癌下颈部淋巴结转移率47.6%(10/21),高于胸中段的21.3%(13/61)及胸中、下段的19.5%(17/87)(P<0.05);胸上段食管癌行i野淋巴结清扫占57.1%(12/21),高于胸中段的23.0%(14/61)及胸中、下段的21.8%(19/87)(P<0.05);三野组3年生存率46.2%(6/13),二野组42.9%(15/35)(P>0.05).结论 胸段食管癌下颈部淋巴结转移以区域性转移为主;术前应用彩色超声加CT判断下颈部淋巴结有无转移的方法是可行的;胸上段食管癌主张行二野淋巴结清扫,胸中、下段食管癌则视彩色超声加CT对下颈部的探查结果,有选择地行三野淋巴结清扫.

Study on the extent of lymphadenectomy in thoracic esophageal carcinoma

Objective To study the rule of lower-cervical lymphatic metastasis in thoracic esophageal carcinoma,and make evaluation about the reasonable extent of lymphadenectomy. Methods One hundred and eight cases of thoracic esophageal carcinoma through chromatic ultrasound and CT before operation were divided into different groups selectively,while three fields lymphadenectomy (3-FL) was adopted in 31 cases,and two fields lymphadenctomy (2-FL) was adopted in 77 cases. Results The rate of lower-cervical lymphatic metastasis was 87.1%(27/31) through chromatic ultrasound and CT,and that was 25.0%(27/108) before the two up-mentioned examinations (P<0.05). In all cases, the rate of lower-cervical lymphatic metastasis in the upper pectoral esophageal carcinoma was 47.6% (10/21),that in the middle pectoral esophageal carcinoma was 21.3%(13161),and that in the middle and lower pectoral esophageal carcinoma was 19.5%(17187) ,P<0.05. Through 3-FL, the rate of lower--cervical lymphatic metastasis in the upper pectoral esophageal eareinoma was 57.1%(12/21), that in the middle pectoral esophageal carcinoma was 23.0%(14/61), and that in the middle and lower pectoral esophageal carcinoma was 21.8%(19/87), P<0.05. Conclusions The regionality metastasis is the main fashion in thoracic esophageal carcinoma with lower-cervical lymphatic metastasis. It is feasible to judge lower-cervical lymphatic metastasis through chromatic ultrasound and CT before operation.The 3-FL of the upper pectoral esophageal carcinoma is recommended. The 3-FL is selectable in the middle and lower pectoral esophageal carcinoma according to the result of chromatic ultrasound and CT.