胸段食管鳞癌腹腔淋巴结转移特点及广泛清除的临床意义

目的:了解胸段食管鳞癌腹腔淋巴结转移特点及对预后的影响,探讨合理的腹腔淋巴结清除范围。方法:对241例手术切除胸段食管鳞癌患者的临床资料进行回顾性分析。结果:腹腔淋巴结转移率32·4%,转移度9·8%。肝总动脉旁、腹腔动脉旁及肝十二指肠韧带内淋巴结转移度分别为6·6%、6·9%和6·3%。影响腹腔淋巴结转移的因素为肿瘤部位、浸润深度及组织分化程度。患者术后3年腹腔局部复发率为5·4%。有腹腔淋巴结转移患者的术后3年生存率为42·3%,低于无淋巴结转移患者的70·6%,P<0·01。结论:腹腔淋巴结转移是影响食管癌切除患者预后的一个主要因素,对腹腔淋巴结的广泛清除可以降低术后的局部复发率。

Characteristics of abdominal lymph node metastases of squamous-cell carcinoma on thoracic esophagus and its clinical significance on extensive dissection

OBJECTIVE:To study the characteristics of abdominal lymph node metastases of squamous-cell carcinoma of thoracic esophagus and its influence on patients prognosis and to find reasonable dissecting range of abdominal lymph node. METHODS: The clinical date of 241 patients who had undergone resection of thoracic esophageal carcinoma were analysed retrospectively. RESULTS: Abdominal lymph node metastases were found in 78 of the 241 treated patients (32.4%). In 3 181 abdominal lymph nodes dissected, metastases existed in 312(9.8%). Lymph node metastatic rates of common hepatic artery, celiac trunk and hepatoduodenal ligament were 6.6%,6.9% and 6.3% respectively. Tumor site, tumor differentiation and the depth of tumor invasion were factors influencing abdominal lymph node metastases. The abdominal local recuring rate was 5.4% in the postoperative. The 3-year survival rate of the patients with lymph node metastasis was 42.3%, being much lower than that of patients with no lymph node metastasis (51.9%),P<0.01. CONCLUSION: Abdominal lymph node metastasis is one of key factors affecting the prognosis of patients, it could decrease postoperative local recuring rate by extensive dissecting abdominal lymph node.