食管癌术后颈部淋巴转移复发76例临床分析

目的探讨食管癌术后患者颈部淋巴转移复发的早期诊断，再治疗方法和临床疗效。方法回顾性分析我院胸外科15年间再次收治的食管癌术后颈部淋巴转移复发的76例患者，实施定期颈部超声检查的方法对食管癌术后的患者进行监测，及时发现复发病例。采用改良性颈部淋巴清扫再手术切除治疗，观察围手术期情况及术后生存状况。结果全部患者均能够耐受颈部改良淋巴清扫术，无围手术期死亡，不降低术后患者生活质量。术后病理统计表明:食管癌术后患者颈部淋巴转移复发以Ⅵ、Ⅴ和Ⅳ区为主，转移无明确的规律性。术后并发症统计:喉返神经损伤14.5%，颈部乳糜瘘3.9%，术后呼吸系统感染为17.1%。术后1、3、5年生存率分别为76.3%(58/76)、35.5%(27/76)、27.6%(21/76)。结论食管癌术后应定期及时随访，颈部无创超声检查是及时发现食管癌术后患者颈部淋巴转移复发的重要手段，对只存在颈部淋巴转移复发的患者实施再手术治疗，可获得较好的临床疗效和长期生存率，优于常规的放射治疗。再手术治疗是食管癌术后患者颈部淋巴转移复发的主要选择之一，并获得良好的长期生存。

Surgical Experiences in 76 Cases of Lymphatic Metastasis Recurrence with Postesophagectomy

Objective To explore the early diagnosis,reoperation and the clinical effect of the cervical lymphatic metastatic recurrence in the esophagectomy.Methods Seventy-six cases with lymphatic metastasis recurrence were retrospectively analyzed in the post 15 years in our chest surgery.They were monitored by the cervical ultrasound and were diagnosed in time.All the patients with esophagectomy were reoperated by modified neck dissection.The perioperative situation and living conditions of these patients were observed.Results All the 76 cases were tolerably able to the modified neck dissection.The perioperative death didn’t occur and the life quality were good.The postoperative pathologic outcome showed that the cervical lymph nodes metastatic recurrence in the postseophagectomy were mostly in the Ⅵ,Ⅴ and Ⅳ areas.But there were no specific transfer regularity.The postoperative complications were observed in 17.1% of respiratory infection.14.5% of recurrent laryngeal nerve damage,and 3.9% of chylous fistula.After the reoperation,1-,3-and 5-year survival rates was 76.3%(58/76),35.5%(27/76),27.6%(21/76),respectively.Conclusion The timely follow up to the patients with postesophagectomy is very necessary.The neck ultrasound examination and fine-needle biopsy play an important roles in discovering the cervical lymph nodes metastatic recurrence.Taking reoperation can obtain better clinical effect.The living quality could be improved and the survival term could be prolonged for the only cervical lymphatic metastatic recurrence with postesophagectomy.There is superior to the general radiotherapy.Reoperation is one of the main choices for the patients in cervical lymphatic relapse with postesophagectomy which is valuable to be recommended in clinic.