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目的 探讨术前化疗对中晚期食管癌转移淋巴结的治疗作用和临床应用价值。方法 对 1996年 5月～1999年 12月收治且资料完整的中晚期食管癌患者 97例的手术后原发灶和淋巴结的病理结果进行分析 ,术前化疗组 6 2例 ,单纯手术组 35例。结果 原发灶组织学完全缓解 7例 ,4例原发灶无癌细胞残留 :但 1例有纵隔淋巴结转移 ,3例有腹腔淋巴结转移。 7例病变仅仅浸及黏膜下。术前化疗组纵隔淋巴结转移比例和转移度分别为16 1%和 4 7% ,单纯手术组为 6 5 7%和 34 2 % ,术前化疗组腹腔淋巴结转移比例和转移度分别为 2 5 8%和6 6 % ,单纯手术组为 48 6 %和 12 0 % ,两者差异显著 (P <0 .0 5 )。结论 术前化疗对转移淋巴结有治疗作用 ,术前化疗组手术后转移淋巴结的完全缓解率较低可能是食管癌术前化疗 +手术治疗后远期效果不佳的原因。对术前化疗有效的患者 ,原发病灶的完全切除和区域淋巴结的彻底清扫十分重要
Objective To investigate the therapeutic effect and clinical value of preoperative chemotherapy on lymph node metastasis of advanced esophageal cancer. Methods The pathologic findings of 97 cases of primary esophageal cancer and lymph nodes in patients with advanced esophageal cancer who were admitted to our hospital from May 1996 to December 1999 were analyzed. There were 62 cases in the preoperative chemotherapy group and 35 cases in the simple operation group . Results Histology of the primary tumor was completely relieved in 7 cases and no residual cell in 4 primary tumors was found. However, one case had mediastinal lymph node metastasis and 3 cases had celiac lymph node metastasis. Seven lesions were submerged only in the submucosa. The proportions and degrees of metastasis of mediastinal lymph nodes in the preoperative chemotherapy group were 16 1% and 47% respectively, while those in the simple operation group were 67 57% and 34 2%. The rates and degrees of peritoneal lymph node metastasis in the preoperative chemotherapy group were respectively 2 58 % And 66%, respectively. The surgical operation group was 48.6% and 120% respectively, with significant difference (P <0.05). Conclusions Preoperative chemotherapy has a therapeutic effect on metastatic lymph nodes. The low complete remission rate of metastatic lymph nodes after operation in preoperative chemotherapy group may be the reason for the poor long-term effect of preoperative chemotherapy and surgical treatment of esophageal cancer. For patients who are effective in preoperative chemotherapy, complete resection of primary lesions and thorough regional lymph node dissection are important