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目的回顾分析食管癌术后食管气管沟淋巴结转移与放疗等因素的关系。方法对经术后CT及临床检查无食管气管沟淋巴结转移、就诊资料完整的食管癌患者101例,就其随访资料中食管气管沟淋巴结情况进行统计分析。101例中未予锁骨上放疗者30例(A组);行锁骨上放疗共71例,剂量<45 Gy 52例(B组),≥45 Gy 19例(C组)。照射采用60Coγ线或6 MV X线,下界常规为锁骨头下缘,按5 cm深计算肿瘤量。结果食管气管沟淋巴结转移率A组20.0%(6/30),B组9.6%(5/52),C组0.0%(0/19)。多因素分析显示食管癌术后锁骨上野的放疗是影响食管气管沟淋巴结转移的惟一因素(P=0.037),而与性别、病理分期、术前病变部位无关(P>0.10)。单因素分析放疗剂量与食管气管沟淋巴结转移结果显示,C组优于A组(P=0.039);A组与B组及B组与C组间均无差异,但A、B、C组有降低食管气管沟淋巴结转移的趋势性。结论食管癌术后锁骨上野放疗的剂量应以食管气管沟深度(常规5 cm)计算,且预防剂量至少要45 Gy。
Objective To retrospectively analyze the relationship between postoperative esophageal tracheal tubal lymph node metastasis and radiotherapy and other factors. Methods 101 patients with complete esophageal cancer who underwent CT and clinical examination without esophageal tracheal glottic lymph node metastasis were enrolled in this study. The data of esophageal tracheal lymph nodes in their follow-up data were analyzed statistically. A total of 71 patients underwent supraclavicular radiotherapy at a dose of 45 Gy (group B) and 19 patients (group C ≥ 45). Irradiation with 60Co γ-ray or 6 MV X-ray, the lower boundary is generally the lower edge of the collarbone, calculated by 5 cm deep tumor volume. Results The rate of lymph node metastasis in esophageal trachea was 20.0% (6/30) in group A, 9.6% (5/52) in group B and 0.0% (0/19) in group C, respectively. Multivariate analysis showed that the radiotherapy of supraclavicular sural esophageal carcinoma was the only factor influencing esophageal tracheal ditch lymph node metastasis (P = 0.037), but not related to gender, pathological stage and preoperative lesion (P> 0.10). Univariate analysis of radiotherapy dose and esophageal tracheal lymph node metastasis showed that group C was superior to group A (P = 0.039); there was no difference between group A and group B and group B and group C, but group A, B and C had Reduce the trend of esophageal tracheal lymph node metastasis. Conclusion The dose of postoperative supraclavicular radiotherapy for esophageal cancer should be calculated based on the depth of esophageal tracheal groove (conventional 5 cm), and the dose of preventive therapy should be at least 45 Gy.