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目的研究胸段食管鳞癌的淋巴结转移规律,探讨合适的淋巴结清扫范围。方法87例接受食管次全切除术的胸段食管鳞癌患者,根据术前食管腔内超声和颈部超声检查结果,选择性进行胸腹二野或颈胸腹三野淋巴结清扫。结果超声发现颈部淋巴结肿大并行三野清扫35例(40．2%,三野清扫组),其中原发肿瘤位于胸上段食管者的比例(16/24例,66．7%)显著高于中、下段肿瘤者(19/63例,30．2%)(P=0．002)。三野清扫术扫除淋巴结13．7组/例,显著多于二野清扫组(52例,59．8%)的10．5组/例(P＜0．001)。术后病理检测三野清扫组转移淋巴结1．5组/例,也显著多于二野清扫组的0．8组/例(P＜0．01)。颈淋巴结转移(pM1-LN)17例(占全组19．5%,占三野清扫组48．6%),有区域淋巴结转移者的颈淋巴结转移比例(15/48例,31．3%)显著高于无区域淋巴结转移者(2/39例,5．1%)(P＜0．01)。上、中、下纵隔及上腹部的淋巴结转移率分别为25．3%、23．0%、5．7%和24．1%,颈淋巴结转移与上纵隔(P＜0．01)及中纵隔(P＜0．01)淋巴结转移显著相关,但与下纵隔及上腹部淋巴结转移无关。三野清扫组术后并发症发生率(60．0%)显著高于二野清扫组(34．6%,P=0．020)。喉返神经损伤发生率两组差异无统计学意义(P＞0．05)；但喉返神经损伤者吻合口瘘发生率(7/13例,53．8%)显著高于无喉返神经损伤者(10/74例,13．5%,P=0．001)。术后死亡率两组差异无统计学意义(P＞0．05)。结论应对肿瘤位于胸上段食管、或上纵隔及中纵隔淋巴结已发生转移的食管癌患者在超声指导下进行选择性颈胸腹三野淋巴结清扫术,以降低手术风险、提高手术根治效果。
Objective To study the rule of lymph node metastasis in thoracic esophageal squamous cell carcinoma and to explore the appropriate range of lymph node dissection. Methods A total of 87 patients with thoracic esophageal squamous cell carcinoma who underwent esophagectomy were enrolled in this study. According to the results of preoperative esophageal endoscopic ultrasonography and cervical ultrasonography, three lymphatic nodes of the thoracic and abdomen or neck and thorax abdomen were selectively dissected. Results In 35 cases (40.2%, Sanye Sweep group), the proportion of primary tumor located in the upper thoracic esophagus (16/24 cases, 66.7%) was significantly higher than that of the control group , The lower tumor (19/63 cases, 30.2%) (P = 0.002). Three wild scans were performed in 13.7 cases / group of lymph nodes, which was significantly more than 10.5 cases / (P <0.001) in Erye Sweep group (52 cases, 59.8%). There were 1.5 cases / case of metastasis lymph node in Mishina group and 0.8 group / case (P <0.01) of Erye Sweep group. Seventeen cases of cervical lymph node metastasis (19.5% of the patients in the whole group and 48.6% of the patients in the three-field dissection group) had cervical lymph node metastasis (15/48 cases, 31.3%), Significantly higher than those without regional lymph node metastasis (2/39 cases, 5.1%) (P <0.01). The rates of lymph node metastasis in the upper, middle and lower mediastinum and upper abdomen were 25.3%, 23.0%, 5.7% and 24.1%, respectively. The rates of cervical lymph node metastasis and the mediastinum (P <0.01) Mediastinal (P <0.01) lymph node metastasis was significantly correlated, but not with the lower mediastinum and upper abdominal lymph node metastasis. The incidence of postoperative complications (60.0%) in San Ye Sweep group was significantly higher than that in Erye Sweeping group (34.6%, P = 0.020). The incidence of recurrent laryngeal nerve injury was no significant difference between the two groups (P> 0.05). However, the incidence of anastomotic fistula (7/13 cases, 53.8%) was significantly higher than that without recurrent laryngeal nerve Injuries (10/74 cases, 13.5%, P = 0.001). Postoperative mortality was no significant difference between the two groups (P> 0.05). Conclusions Selective cervical, thoracic and abdominal three-node lymphadenectomy should be performed under the guidance of ultrasound in order to reduce the risk of surgery and improve the curative effect of radical surgery.