左胸单切口和颈-右胸-腹三切口在食管癌淋巴结清扫中的应用

 目的　比较左胸单切口和颈-右胸-腹三切口在食管癌根治手术中的淋巴结清扫情况，探讨食管癌手术中合理的淋巴结切除范围。方法　回顾性分析2006年1月至2008年1月行食管癌根治手术的95例患者的临床资料，根据手术方式分为左胸切口组62例和三切口组33例，对淋巴结清扫状况和术后并发症进行分析。结果　95例患者共切除1322枚淋巴结，平均每例切除13.9枚。95例中有43例（45.3 %）出现淋巴结转移。左胸切口组和三切口组淋巴结转移率分别为40.3 %（25／62）和54.5 %（18／33）。上段和中段食管癌的颈部淋巴结转移率分别为25.0 %（2／8）和40.0 %（4／10），下段食管癌的腹部淋巴结转移率为53.8 %（7／13）。食管癌的浸润深度（r＝0.315，P＝0.007）和分化程度（r＝0.239，P＝0.017）与淋巴结转移显著相关。肿瘤长度＞2 cm时淋巴结转移率明显增高（χ2＝34.2，P＜0.001）。左胸切口组和三切口组患者术后并发症发生率分别为25.8 %（16／62）和4.2 %（8／33），差异无统计学意义（χ2＝0.017，P＝0.869）。围手术期死亡率分别为1.6 %（1／62）和3.0 %（1／33），差异无统计学意义（χ2＝0.047，P＝0.651）。结论　食管癌根治手术应综合考虑肿瘤浸润深度、分化程度和长度对淋巴结转移的影响。对于上、中段食管癌宜选择三切口利于行术野淋巴结切除，下段食管癌应重视腹腔淋巴结的切除。

Clinical analysis of lymphadenectomy in patients with esophageal carcinoma underwent single left thoracal incision and cervico-right thoracic-abdominal triple incision

Objective　To explore the extent of lymphadenectomy by comparing the single left thoracotomy and cervico-right thoracic-abdominal triple incision during esophageal carcinoma radial surgery. Methods　The clinical data of 95 patients with thoracic esophageal carcinoma underwent esophagectomy plus lymphadenectomy were studied. They were divided into two groups, left thoracotomy group (62 cases) and triple incision group (33 cases). The rates of lymph node metastasis and postoperative complications were analyzed statistically. Results　A total of 1322 lymph nodes were dissected with an average of 13.9 lymph nodes in each case. The rates of lymph node metastasis were 45.3 % (43/95) of all patients, 40.3 % of left thoracotomy and 54.5 % of triple incision. The rates of lymph node metastasis in the neck for patients with upper or middle thoracic esophageal carcinoma were 25.0 % (2/8) and 40.0 % (4/10). The rate of abdominal lymph node metastasis was 53.8 % (7/13) in lower thoracic carcinoma. The depth of tumor invasion (r = 0.315, P = 0.007) and tumor differentiation (r = 0.239, P = 0.017) were correlated to lymph node metastasis. Patients with tumor length >2 cm had higher rates of lymph node metastasis (χ2 = 34.2, P < 0.001). The postoperative complication rates of left thoracotomy and triple incision were 25.8 % (16/62) and 4.2 % (8/33). The mortalities rates of left thoracotomy and triple incision were 1.6 % (1/62) and 3.0 % (1/33). There was no significant difference in postoperative complication rates (χ2 = 0.017, P = 0.869) and mortalities rates (χ2 = 0.047, P = 0.651) between the two groups. Conclusion　Tumor invasion, differentiation and length should be incorporated in the evaluation of lymph node status. Patients with upper and middle thoracic esophageal carcinoma should receive cervico-right thoracic-abdominal triple incision. Particular attention should be given to the resection of abdominal lymph nodes in patients with lower thoracic esophageal carcinoma.