经右胸途径颈段、胸上段食管癌切除并三区淋巴结清扫术的外科治疗评价

目的 评价经右胸途径颈段、胸上段食管癌切除并三区淋巴结清扫术的临床意义。方法 采用颈、胸、腹三切口，同时进行颈、胸、腹三区淋巴结清扫，治疗颈、胸上段食管癌104例。总结并探讨颈部及上纵隔淋巴结转移规律。分析病变长度、外侵程度与切除率的关系及主要并发症的危险性。结果 颈部及最上纵隔(右胸顶)淋巴结转移率及转移度分别为47．11％(49／104)及13．27％(114／859)。其中，左气管旁淋巴结分别为17．31％(18／104)及11．46％(25／218)；左颈深下淋巴结分别为7．69％(8／104)及8．13％(17／209)；右气管旁淋巴结分别为12．50％(13／104)及10．61％(19／179)；右颈深下淋巴结分别为11．54％(12／104)及11．86％(21／177)；右胸顶淋巴结分别为17．30％(18／104)及42．10％(32／76)。全组手术切除率为100．00％(104／104)。主要并发症：吻合口瘘发生率为16．34％(17／104)；肺部并发症发生率为8．65％(9／104)；喉返神经损伤发生率为9．6196(10／104)；上消化道梗阻发生率为0．9696(1／104)；死于肺部并发症所致的呼吸衰竭2例，病死率为1.92％(2／104)。结论 经右胸途径食管癌切除并三区淋巴结清扫术是治疗颈、胸上段食管癌较为有效的手术方式。

Evaluation of Esophagectomy with Three-field Lymphadenectomy via Right Thoracotomy for Patient with Cervical and Thoracic Esophageal Carcinoma

Objective To evaluate the significance of esophagectomy with three-field lymphadenectomy via right thoracotomy for patient with cervical and thoracic Esophageal Carcinoma.Methods 104 cases with cervical or upper thoracic esophageal carcinoma underwent esophagectomy with three-field lymphadenectomy(neck,mediastinum and abdomen).The lmphy node metastases in the neck and upper mediastinum was studied.The length of the lesion,invasion and the resectable rate were reviewed and the risk of the main complications was analyzed.Results The metastasis rate and the metastasis degree of cervical and upper mediastinum lymph nodes were 47.11%(49/104) and 13.27%(114/859),respectively.Among them,the metastasis rate and the metastasis degree were 17.31%(18/104)and 11.46%(25/218) in the left paratracheal nodes,7.69%(8/104)and 8.13%(17/209) in the left inferior deep cervical nodes,12.50%(13/104)and 10.61%(19/179) in the right paratracheal nodes,11.54%(12/104)and 11.86%(21/177) in the right inferior deep cervical nodes.The resection rate were 100.00%(104/104).The main complications included anastomotic leak(16.34%,17/104),lung deseases( 8.65%,9/104),injury of recurrent nerve(9.61%,10/104),the obstruction of upper digestive tract(0.96%,1/104).The mortality rate was 1.92%(2/104),due to the respiratory failure resulted from the complication in the lung.Conclusion The esophagectomy with three-field lymphadenectomy is effective for patients with cervical and upper thoracic esophageal cancer.