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背景与目的:食管切除局部区域淋巴清扫是胸下段食管癌的主要治疗手段。本研究旨在评价Ivor Lewis食管切除术二野淋巴清扫治疗胸下段食管癌的临床效果。方法:选择1998年1月至2001年12月73例行Ivor Lewis食管切除术二野淋巴清扫的胸下段食管鳞癌病例,观察清扫的淋巴结数目、术后并发症发生率、死亡率等指标,Kaplan-Meier法进行生存分析。结果:术后并发症发生率15.1%,死亡率2.7%。淋巴结转移率71.2%,上纵隔淋巴转移率17.8%。Ⅰ期5例,Ⅱ期34例,Ⅲ期32例,Ⅳ期2例。总的5年生存率为23.3%。N0与N1病例5年生存率分别为38.1%与17.3%(P<0.01)。ⅡA、ⅡB、Ⅲ期病例的5年生存率分别是31.2%、27.8%、12.5%(P<0.01)。结论:Ivor Lewis食管切除术二野淋巴清扫治疗胸下段食管鳞癌是一项安全的手术,可增加完整切除(肉眼及镜下均无癌残留)机会。
BACKGROUND & AIM: Esophagectomy is the main treatment for esophageal cancer in the thoracic segment. This study was designed to evaluate the clinical efficacy of Ivor Lewis esophagectomy with two-site lymphadenectomy in the treatment of lower thoracic esophageal cancer. Methods: From January 1998 to December 2001, 73 cases of esophageal squamous cell carcinoma of the lower thoracic segment undergoing Ivan Lewis esophagectomy were enrolled in this study. The number of dissected lymph nodes, the incidence of postoperative complications and mortality were observed. Kaplan-Meier method for survival analysis. Results: The incidence of postoperative complications was 15.1% and the mortality rate was 2.7%. Lymph node metastasis rate was 71.2%, lymph node metastasis rate was 17.8%. 5 cases of stage Ⅰ, 34 cases of stage Ⅱ, 32 cases of stage Ⅲ, 2 cases of stage Ⅳ. The overall 5-year survival rate was 23.3%. The 5-year survival rates of N0 and N1 cases were 38.1% and 17.3%, respectively (P <0.01). The 5-year survival rates of stage IIA, IIB and III were 31.2%, 27.8% and 12.5%, respectively (P <0.01). Conclusions: Ivor Lewis esophagectomy with two-site lymphadenectomy for the treatment of lower thoracic esophageal squamous cell carcinoma is a safe procedure that increases the chances of a complete resection that is free from cancer and remains under the microscope.