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目的对比食管磷癌选择性三野淋巴结清扫与二野淋巴结清扫的近期临床疗效。方法回顾性分析2013年5月至2015年10月在扬州市江都人民医院行开放食管癌根治术的85例患者临床资料,其中行选择性三野淋巴结清扫35例(三野组,行颈、胸、腹三切口手术),行二野淋巴结清扫50例(二野组,右胸、上腹二切口手术)。比较两组患者的围手术期并发症和淋巴结清扫数目及淋巴结转移率等指标。结果 (1)无围手术期死亡病例。二野组手术时间、住院时间短于三野组,平均淋巴结清扫个数少于三野组,淋巴结转移率低于三野组,差异均有统计学意义(P<0.05,P<0.01)。两组术中出血量、术后拔管时间比较差异无统计学意义(P均>0.05)。(2)85例均获随访,随访截止日期至2016年4月。三野组随访6~27个月,中位时间为19个月。二野组随访17~29个月,中位时间为23个月。失访1例,死亡2例,余82例健在。二野组喉返神经损伤发生率明显低于三野组(P<0.05)。二野组肺部感染、吻合口狭窄、急性胃排空障碍、心律失常、吻合口漏发生率稍低于三野组,差异无统计学意义(P均>0.05)。结论胸中上段食管癌行选择性三野淋巴结清扫术在技术上是安全可行的,手术并发症和二野淋巴结清扫术相当,三野淋巴结清扫术能够彻底清除淋巴结,增加术后分期的准确性,近期疗效可靠,有可能筛选出获益的人群,远期疗效有待进一步随访及研究。
Objective To compare the short-term clinical efficacy of selective three-field lymph node dissection and second field lymph node dissection for esophageal P-cancer. Methods Retrospectively analyzed the clinical data of 85 patients who underwent radical resection of esophageal cancer in Jiangdu People’s Hospital of Yangzhou from May 2013 to October 2015. Among them, 35 patients with selective three-field lymph node dissection (Sanye group, neck, chest, and Three abdominal incisions were performed. 50 lymph node dissections were performed in the second field (secondary group, right chest and upper abdominal incisions). The perioperative complications, number of lymph node dissections and lymph node metastasis were compared between the two groups. Results (1) There were no perioperative deaths. The operation time and length of stay in the Miye group were shorter than those in the Sanye group. The average number of lymph node dissections was less than the Sanye group, and the lymph node metastasis rate was lower than that in the Sanye group. The difference was statistically significant (P<0.05, P<0.01). There was no significant difference in the amount of intraoperative blood loss and postoperative extubation time between the two groups (all P>0.05). (2) All 85 patients were followed up until April 2016. Sanye group was followed up for 6-27 months with a median time of 19 months. The Miyoshi group was followed up for 17 to 29 months with a median time of 23 months. One case was lost to follow-up, 2 cases died, and 82 cases remained. The incidence of recurrent laryngeal nerve injury in the Erye group was significantly lower than that in the Sanye group (P<0.05). The incidence of lung infection, anastomotic stenosis, acute gastric emptying, arrhythmia, and anastomotic leak in the Erye group was slightly lower than that in the Sanye group, with no statistically significant difference (P>0.05). Conclusions Selective three-field lymph node dissection for middle-to-upper thoracic esophageal cancer is technically safe and feasible. Surgical complications are equivalent to two-field lymph node dissection. Three-field lymph node dissection can completely remove lymph nodes and increase the accuracy of postoperative staging. Reliable, it is possible to screen out the benefit of the population, long-term efficacy needs further follow-up and research.