胸段食管癌淋巴结转移特点的研究

目的探讨胸段食管癌淋巴结转移的特点,指导食管癌淋巴结清除术及为术后综合治疗方案的制定提供依据。方法回顾性分析2002年1月至2004年12月河南省肿瘤医院胸外科收治的623例胸段食管癌患者的手术及病理资料,分析其淋巴结转移特点。结果全组共清除3689组淋巴结（8603枚）,淋巴结转移率47．2％,淋巴结转移度10．3％;Tis期食管癌无淋巴结转移,T1期以后各期食管癌均可见淋巴结转移。不同T分期胸段食管癌间,淋巴结转移率和转移度差异均有统计学意义（x^2=38,407,P=0．000和x^2=118．438,P=0．000）;随T分期增加,淋巴结转移率和转移度均增加,两者间存在显著相关关系（r=1,P=0．000;r=1,P=0．000）;不同病理类型的胸段食管癌间,其淋巴结转移率差异并无统计学意义（x^2=6．284,P=0．179）,而淋巴结转移度差异存在统计学意义（x^2=84．577,P=0．000）,食管腺鳞癌、腺癌、小细胞癌的淋巴结转移率及转移度均明显高于食管鳞癌;食管癌淋巴结转移具有上下双向性和跳跃性;各段食管癌均可以发生腹腔淋巴结转移,胸下段食管癌腹腔淋巴结转移率和转移度最高。结论食管癌淋巴结清除应适度,应重视对腹腔淋巴结的清除;在保证手术的相对彻底性的基础上,根据淋巴结转移趋势及其他一些指标,尽早接受合理的多学科综合治疗才应该是食管癌治疗的方向。

Characteristics of lymph node metastasis in thoracic esophageal carcinoma

OBJECTIVE: To investigate the frequency, distribution, and feature of lymph node metastasis in thoracic esophageal carcinoma, and to provide evidence for lymph node dissection and the multidisciplinary therapy for patients with esophageal carcinoma postoperatively. METHODS: The clinical data of 623 patients with thoracic esophageal carcinoma who had undergone esophagectomy plus lymph node dissection were studied to analyze the characteristics of lymph node metastasis. RESULTS: Totally 3689 of lymph node groups (with 8603 nodes) were dissected. The lymph node metastasis rate was 47.2% and lymph node metastasis ratio was 10.3%. No lymph node metastasis was found in the patients of Tis stage, while lymph node metastasis was found in the patients of other stages. There were significantly differences in lymph node metastasis rate and ratio among the patients of different T stages (chi2 = 38.407, P = 0.00, and chi2 = 118.438, P = 0.000). The higher the T stage, the higher the lymph node metastasis rate and ratio (r = 1, P = 0.000, and r = 1, P = 0.000). Different pathological types of esophageal carcinoma had different lymph node metastasis ratio (chi2 = 84.577, P = 0.000), however, there was no significant difference in lymph node metastasis rate among different pathological types (chi2 = 6.284, P = 0.179). The patients with squamous carcinoma had the lowest lymph node metastasis ratio and lymph node metastasis rate. The lymph node metastasis was mainly regional and extended vertically in both directions. Leaping over metastasis was another feature. All segments of thoracic esophageal carcinoma, especially lower thoracic esophageal carcinoma, could metastasize to the celiac lymph nodes. CONCLUSION: Lymph node dissection should be carried out properly in treatment of esophageal carcinoma and regional celiac lymph nodes should be explored and dissected more cautiously. Because surgical treatment is relatively radical in treatment of esophageal carcinoma, and taking the trend of lymph node metastasis and other indication into account, rational multidisciplinary therapy conducted as soon as possible should be adopted in the treatment of esophageal carcinoma.