胸段食管癌颈、胸、腹三区域淋巴结清扫术临床应用

目的通过颈、胸、腹三区域淋巴结清扫提高胸段食管癌的手术根治性和外科的正确分期。方法49例胸段食管癌患者在切除肿瘤的同时接受了颈、胸、腹三区域淋巴清扫术,清扫范围包括双侧下颈中央区,锁骨上区,和全纵隔及上腹部区域淋巴结。结果47例患者获根治性切除,术后并发症6例(12.8%),无手术死亡,34例(72.3%)淋巴结受累。颈部、纵隔、和腹部淋巴结转移率分别为38.3%、53.2%、12.7%(P>0.05)。结论胸段食管癌早期即可发生广泛及跳跃性淋巴结转移,扩大淋巴结清扫范围有利于提高手术根治性和外科分期的正确性。

Extended three-field(cervical,thoracic and abdominal)lymph node dissection for the racic esophageal carcinoma and its clinical significance

Objective To improve radical resection rate and the accuracy of surgical stage for thoracic esophageal carcinoma through extended three-field lymph node dissection.Methods 47 patients with thoracic esophageal carcinoma underwent tumor resection and extended three-field(cervical,thoracic and abdominal) lymph adenectomy.The extent of lymph node dissection included two cervicos.upper -clavicules,total mediastinums and up per abdominal lymph nodes.Results Among 47 cases underwent radical resection,6 cases developed postoperative complications.No case died after operation.Regional lymph node metastasis occurred in 34(34/47.72.3%) cases.The metastasis rates of lymph nodes in cervix,upper-mediastinum,mid-and inferior mediastinum and upper abdominal lymph nodes were 38.3%,53.2%,12.7%respectively.18 cases with tumor were radically resected and correctly staged as N 1,and would have been resected palliative and misdiagnosed as N 0 stage if they had received routine operations.Conclusion Thoracic esophageal carcinomas are prone to have early,extensive or jump lymph node metastasis.Extend three-field lymph node dissection may help increase radical resection rate and the accuracy of surgical stage for thoracic esophageal carcinoma.