胸段食管鳞癌152例淋巴结转移规律的临床研究

目的：探讨胸段食管癌淋巴结转移规律性。方法：采用右前胸、颈、腹三切口施行三野淋巴结清扫食管癌根治术治疗胸段食管癌152例。结果：医院内手术死亡3例（2．0％），全组病人淋巴结转移率为55．9％（85／152），颈、纵隔、腹腔淋巴结转移率分别为15．1％（23／152）、44．1％（67／152）、22．4％（34／152）。纵隔淋巴结转移与病变部位无关，颈部淋巴结转移多见于胸上、中段食管鳞癌，转移率分别为22．2％（8／36）、16，7％（13／78）；腹腔淋巴结转移多见于胸中、下段食管鳞癌，转移率分别为23．1％（18／78）、34．2％（13／38）；颈淋巴结转移率在PT1～PT3差异无统计学意义（P〉O．05）；PT3、PT4与PT1、PT2纵隔及腹腔淋巴结转移率差异有统计学意义（P＜0．05）。结论：（1）胸段食管癌易发生纵隔、颈部、腹腔淋巴结转移；（2）胸段食管癌浸润早期即可发生颈淋巴结转移；（3）三野淋巴结清扫对胸段食管癌的外科手术治疗有重要意义。

Clinical study in regularity of lymph node metastasis in 152 patients with squamous cell cancer on thoracic esophageal carcinoma

Objective:To explore the regularity of lymph node metastasis in thoracic esophageal carcinoma.Methods:One hundred and fifty-two patients with thoracic esophageal carcinoma underwent radical esophagectomy with three-field lymphadenectomy.Dissection was done through a right thoracotomy followed by simultaneous laparotomy and neck incision.Results:The hospital mortality rate was 2.0 %(3/152).Nodal metastases occurred in 55.9%(85/152) of patients.The rate of metastasis to neck,mediastinum and abdomen were 15.1%(23/152),44.1%(67/152) and 22.4%(34/152) respectively.The rate of mediastinal nodal metastasis was not collated to the site of lesion.Cervical nodal metastasis was correlated with the upper and medial site of lesion and the rate of cervical nodal metastasis were 16.7%(13/78),22.2%(8/36) respectively;the rate of abdominal nodal metastasis were 23.1%(18/78),34.2%(13/38) in medial and lower site of lesion.There were no statistic signifficance in the rate of cervical lymph metastasis among 3 groups in PT1 to PT3(P>0.05).There were statistic signifficance in PT3 and PT4 between PT1 and PT2 in the rate of mediastinal and abdominal(P<0.05).Conclusions:(1) Neck,mediastinum and abdomen nodal metastases occurred frequently in thoracic esophageal carcinoma.(2) Nodal metastasis could occur in early stage of tumor infiltration.(3) 3-field lymphadenectomy was a very important factor for accurate staging of thoracic esophageal cancer.