选择性三野淋巴结清扫治疗胸中下段食管癌

目的探讨经左胸切口选择性三野淋巴结清扫术治疗胸中下段食管癌手术方法及淋巴结清扫效果。方法2005年6月至2009年3月手术治疗胸中下段食管癌213例，采用左胸第6肋间切口，对纵隔左右两侧同时进行淋巴清扫，并切除左右两侧纵隔胸膜，腹野清扫1—5组，7—12a组，16al、19组淋巴结，颈野仅做食管系膜内淋巴结摘除。结果213例共检出淋巴结14197枚，平均（66．65±24．73）枚；淋巴结转移105例，转移率49．29％（105／213），转移淋巴结423枚，转移度2．97％（423／14197），术后病理检查食管标本上下切缘均无癌残留。手术时间2．92～4．67（3．37±0．42）h，术中术后输红细胞0—6^u（1．08±0．93）^u；术中术后输血浆0—1400（103．77±184．89）ml；住院时间14—39（17．64±4．12）d。无喉返神经损伤，无吻合口瘘。1例死于呼吸衰竭，死亡率0．04％（1／213）。结论经左胸第6肋间切1：3，扩大了标准三野清扫术中的胸野淋巴结清扫范围，缩小了颈野淋巴结清扫范围，上腹部和胃周围淋巴结清扫达到选择性队水平，手术创伤小，术后并发症少。

Selected three-field lymphadenectomy in thoracic middle-lower section esophageal carcinoma

Objective To explore the technique and effect of selected three-field lymphadenectomy by left thoracotomy in treatment of thoracic middle or lower section esophageal squamous carcinoma. Methods From Jun. 2005 to Mar. 2009, 213 patients with thoracic middle or lower section of esophageal carcinoma received esophagectomy, bilateral mediastinal lymphadenectomy and pleural membrane resection.Group 1 -5, 7 - 12a, 16al, and 19 were performed to dissect abdominal lymph node and extended thoracic and abdominal lymphadenectomy and only lymph node extraction of mesoesophagus in neck field. Results 14197 lymphatic nodes(LN) were detected in 213 case. The average number of resected LN was 66. 65 ±24. 73. The metastatic lymph node was detected in 105 cases. The metastatic rate was 49.05% (105/213).There were 423 metastatic lymph nodes. The lymph nodes metastasis was 2. 97% (423/14197) of all dissected lymphatic nodes. No remnant carcinoma in the upper and lower cutting edge was found in pathological examination. The operation time ranged from 2. 92 ～ 4. 67 ( 3. 37 ± 0. 42) hours. Blood transfusion during perioperative period was 0 ～ 6u ( 1.08 ± 0. 93 ) u. Perioperative plasma transfusion was 0 ～ 1400( 103.77 ± 184. 89) ml. The hospital-time was 14 ～ 39 ( 17.64 ±4. 12) days. There were no anastomotic leakage and recurrent laryngeal nerve injury. One case died from respiratory failure, the mortality was 0. 04% ( 1/213). Conclusion Surgical approach in the management of left thoracotomy in the sixth intercostals could extend resection of chest-field lymph node dissection, decrease neck field lymph node dissection. Abdomen-field lymph node dissection reached selected D3. The selected lymphadenectomy procedure had the advantages of small traumas and few complications.