胸段食管鳞癌淋巴结转移规律及淋巴结清扫方式探讨

目的探讨胸段食管鳞癌淋巴结转移规律及术中淋巴结清扫方式。方法 480例行根治术的胸段食管鳞癌患者,标记各部位清扫淋巴结分别送检,进行临床病理资料分析。结果本组386例患者有淋巴结转移。全组清扫淋巴结5 424枚,平均每例清扫11.3枚,689枚淋巴结有转移。22例患者出现跳跃性淋巴结转移,其中胸上段3例、中段9例、下段1例。胸上段食管鳞癌颈部淋巴结转移率47.6%,高于胸中段（10.5%）和胸下段（1.3%）,P均〈0.05。胸下段食管鳞癌向腹腔淋巴结转移率为33.1%,高于胸中段（19.4%）和胸上段（3.8%）,P均〈0.05。胸中段食管鳞癌有上纵隔淋巴结（23.5%）及下纵隔淋巴结（29%）和腹腔淋巴结（19.4%）的双向转移趋势,隆突下淋巴结转移多见,转移率54.2%。结论 胸上段食管癌淋巴结转移以颈段食管旁、锁骨上、上中纵隔转移多见,胸中段食管癌淋巴结转移具有明显的上下双向转移和跳跃性转移特点,胸下段食管癌淋巴结转移以腹部、中下纵隔转移多见。胸上段食管癌行颈、胸、腹三野淋巴结清扫,重点清扫颈段食管旁及锁骨上、下界包括隆突下淋巴结;胸下段食管癌可行胸、腹两野淋巴结清扫,重点清扫隆突下、下胸段食管旁、胃左动脉旁淋巴结;胸中段食管癌淋巴结清扫方式应根据具体情况设定。

Investigate of lymph node metastasis pattern and clinical sphere of lymphadenectomy for thoracic esophageal squamous cell carcinoma

Objective To investigate the lymph node metastasis pattern and clinical sphere of lymphadenectomy for thoracic esophageal squamous cell carcinoma（ESCC）.Methods 480 patients with thoracic esophageal squamous cell carcinoma who had undergone esophagogartrectomy were analized.The pattern of lymph node metastasis was studied by analyzing all the clinical and pathologic materials.Based on these data,the clinical sphere for lymphadenectomy was suggested.Results Lymph node metastasis was detected in 386 patients.5 424 pieces of lymph node was dissect overall,689 lymph node had metastase.22 patients had lymph node metastasis in leaps and bounds,including 3 cases of upper chest,9 cases of middle chest and 1 caseof lower chest.Lymph node metastasis to neck lamph node rate was 47.6% in upper chest ESCC,it was higher than the middle chest（10.5%） and lower chest（1.3%）.Metastasis rate to the abdominal lymph node was 33.1% in lower chest ESCC,.It was higher than the middle chest（19.4%） and upper chest（3.8%）.Conclusions Metastasis to the cervical,supraclavicular and high mediastinal lymph nodes is mainly occurs in patients with the upper thoracic ESCC.The upper thoracic ESCC should perform three field lymphadenectomy,especially include the cervical para-esophageal,supraclavicular lymph nodes and subcardinal lymph nodes.For the lower thoracic ESCC shoulde perform two field lymphadenectomy,including the subcarinal lymph nodes and left gastric lymph nodes.