中段食管癌根治术扩大二野清扫淋巴结的临床体会

目的探讨胸中段食管癌扩大二野清扫的淋巴结转移规律。方法从2008年9月至2012年9月对52例胸中段食管癌患者以Ivor-Lewis术式为基础进行扩大二野清扫,并对淋巴结转移规律进行分析。结果 52例患者并发症发生率为36.5%(19/52),死亡1例。淋巴结转移发生率为50%(26/52)。共清扫淋巴结1 426枚,其中99枚淋巴结发生转移,淋巴结转移度为6.9%;主要集中在颈深组、食管旁、喉返神经旁、隆突下、贲门区和胃左动脉旁,淋巴结转移率分别为17.3%、19.2%、7.6%、13.4%、25%和5.7%;转移度分别为15.2%、17.2%、6.1%、19.2%、24.2%和3.0%。早期食管癌和进展期食管癌淋巴结转移率分别为25%和52.1%,转移度分别为1.9%和7.1%,两者转移率和转移度之间差异均有统计学意义(χ2=2.178、1.083,P<0.05)。结论胸中段食管癌有广泛转移的倾向,颈深区及上纵隔区域是胸段食管癌淋巴结转移的重要区域。Ivor-Lewi术式更方便胸中段食管癌切除和现代二野淋巴结的清扫,并且以此为基础经右胸顶对颈深区淋巴结清扫也是安全可行的。

Regulations and lymphadenectomy strategy of extended 2-field lymph node metastasis in middle thoracic esophageal carcinoma

Objective To investigate the regulations of lymph node metastasis of middle thoracic esophageal carcinoma in the extended 2-field lymphadenectomy and explore the rational lymphadenectomy with Ivor-Lewis procedure.Methods A total of 52 middle thoracic esophageal carcinoma patients underwent radical esophagectomy and extended 2-field lymphadenectomy by Ivor-Lewis procedure from 2008 to 2012 at Hefei 3rd People's Hospital.The regulations of regional lymph node metastasis were analyzed.Results Of the 52 patients,19(36.5%) had postoperative complications,1(1.9%) died during hospitalization,and 26(50%) had lymph node metastasis.Of the 1426 resected lymph nodes,99(6.9%) were positive;the metastasis degree(positive lymph nodes/resected lymph nodes) was 17.3% in the deep in-external,19.2% in the peri-esophageal,7.6% in the recurrent nerve,13.4% in the subcarinal,25% in the paracardiac and 5.7% in the left gastric artery.Both the lymph node metastasis rate and degree were significantly higher in patients at advanced stage than in those at early stage(25% vs 52.1%,1.9% vs 7.1%,P<0.01).Conclusion Regional lymph node metastasis,especially in the deep in-external and upper mediastinum,is a key factor for middle thoracic esophageal carcinoma.Ivor-Lewis esophagectomy with extended 2-field lymph node dissection is a safe operation for middle thoracic esophageal carcinoma,and may increase the chances of complete resection.