不同淋巴结清扫术式对老年胸中上段食管癌患者淋巴结转移复发率、生存时间及并发症的影响

目的 研究二野淋巴结清扫根治术和三野淋巴结清扫根治术对老年胸中上段食管癌患者淋巴结转移复发率、生存时间及并发症的影响.方法 选择2010年1月至2013年6月接受手术治疗的老年胸中上段食管癌患者120例.用随机数表法分为二野组和三野组,每组各60例,二野组患者行二野淋巴结清扫根治术,三野组患者行三野淋巴结清扫根治术。比较2组患者的淋巴结转移复发率、生存率和并发症.结果 三野组患者的淋巴结平均清扫枚数和淋巴结转移率高于二野组,颈淋巴结复发率低于二野组,差异有统计学意义(P＜0.05);2组患者的纵膈淋巴结复发率比较差异无统计学意义(P＞0.05).三野组患者的1年生存率、2年生存率和3年生存率分别为95.00％、83.33％、68.33％，明显高于二野组,差异有统计学意义(P＜0.05).三野组患者的喉返神经损伤和吻合口痿发生率高于二野组,差异有统计学意义(P＜0.05);2组患者的呼吸系统并发症、心血管并发症和胸腔感染发生率比较差异无统计学意义(P＞0.05).结论 三野淋巴结清扫根治术可以更为彻底地清除老年胸中上段食管癌患者的淋巴结,降低局部复发率,提高生存率,但喉返神经损伤和吻合口瘘发生率较高.

Influence of Lymph Node Dissection on Lymph Node Metastasis and Recurrence Rate,Survival Time and Complications of Elderly Patients with Upper and Middle ThoracicEsophageal Carcinoma

Objective To study the effect of two-field lymph node sweeping radical operation and three-field lymph node sweeping radical operation on lymph node metastasis and recurrence rate,survival time and complications of elderly patients with upper and middle thoracic esophageal carcinoma.Methods 120 cases of elderly patients with upper and middle thoracic esophageal cancer who accepted surgical treatment were divided into two-field group and three-field group with the random number table method,each group had 60 cases,two-field group underwent two-field lymph node dissection in radical resection,three-field group underwent three-field lymph node sweep radical operation.The recurrence rate,survival rate and complication rate of lymph node metastasis between the 2 groups were compared.Results Three-field group of patients with lymph node average cleaning gold and number of lymph node metastasis was significantly higher than that of the second field army group,cervical lymph node recurrence rate is lower than that of the second field army group,the difference had statistical significance(P＜0.05),the 2 groups of patients with meditational lymph node recurrence rate had no statistical significance(P＞0.05).Three-field group,1-,2-and 3-year survival rates were 95.00%,83.33% and 68.33%,and was significantly higher than that of the second field army group,the difference had statistical significance(P＜0.05).Three-field group of patients with larynx return nerve injury and anastomotic leakage rate was higher than that of the second field army group,the difference had statistical significance(P＜0.05),the 2 groups of patients with respiratory system complications,cardiovascular complications and pleural infection incidence rate had no statistical significance(P＞0.05).Conclusion Three-field lymph node dissection in radical resection can more thoroughly remove lymph nodes in the elderly patients with thoracic esophageal carcinoma and reduce the local recurrence rate and increase survival rate,but recurrent laryngeal nerve injury and anastigmatic leakage rate are higher.