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目的 评价经右胸途径颈段、胸上段食管癌切除并三区淋巴结清扫术的临床意义。方法 采用颈、胸、腹三切口 ,同时进行颈、胸、腹三区淋巴结清扫 ,治疗颈、胸上段食管癌 10 4例。总结并探讨颈部及上纵隔淋巴结转移规律。分析病变长度、外侵程度与切除率的关系及主要并发症的危险性。结果 颈部及最上纵隔 (右胸顶 )淋巴结转移率及转移度分别为 47.11% ( 4 9/10 4)及13 .2 7% ( 114 /85 9)。其中 ,左气管旁淋巴结分别为 17.3 1% ( 18/10 4)及 11.46% ( 2 5 /2 18) ;左颈深下淋巴结分别为 7.69% ( 8/10 4)及 8.13 % ( 17/2 0 9) ;右气管旁淋巴结分别为 12 .5 0 % ( 13 /10 4)及 10 .61% ( 19/179) ;右颈深下淋巴结分别为 11.5 4% ( 12 /10 4)及11.86% ( 2 1/177) ;右胸顶淋巴结分别为 17.3 0 % ( 18/10 4)及 42 .10 % ( 3 2 /76)。全组手术切除率为 10 0 .0 0 % ( 10 4/10 4)。主要并发症 :吻合口瘘发生率为 16.3 4% ( 17/10 4) ;肺部并发症发生率为 8.65 % ( 9/10 4) ;喉返神经损伤发生率为 9.61% ( 10 /10 4) ;上消化道梗阻发生率为 0 .96% ( 1/10 4) ;死于肺部并发症所致的呼吸衰竭 2例 ,病死率为 1.92 % ( 2 /10 4)。结论 经右胸途径食管癌切除并三区淋巴结清扫术是治疗颈、胸上段食管癌较为有效的手?
Objective To evaluate the clinical significance of resection of the upper and lower thoracic esophagectomy and regional lymph node dissection through the right thoracic approach. Methods The cervical, thoracic and abdominal incisions were made. The lymph nodes of the neck, thorax and abdomen were simultaneously dissected to treat 104 cases of esophageal carcinoma in the upper and upper thoracic segments. To summarize and explore the neck and the mediastinal lymph node metastasis. Analysis of the length of the lesion, the extent of external invasion and resection rate and the risk of major complications. Results The rates of lymph node metastasis in the neck and the uppermost mediastinum (right chest top) were 47.11% (49/104) and 13.27% (114/85 9), respectively. Among them, the left paratracheal lymph nodes were 17.3% (18/104) and 11.46% (2/5/18) respectively. The left lower cervical lymph nodes were 7.69% (8/104) and 8.13% (17/2 0 9). The right paratracheal lymph nodes were 12.5% (13/104) and 10.61% (19/179) respectively. The right lower cervical lymph nodes were 11.5 4% (12/104) and 11.86 % (2 1/177). The right chest lymph nodes were 17.3% (18/104) and 42.10% (3/2/76) respectively. The total resection rate was 100.0% (104/104). The main complications were anastomotic leakage rate of 16.3 4% (17/10 4), pulmonary complication rate of 8.65% (9/10 4) and recurrent laryngeal nerve injury rate of 9.61% (10/10 4) ). The incidence of upper gastrointestinal obstruction was 0.96% (1/10 4). Two patients died of respiratory failure caused by pulmonary complications and the case fatality rate was 1.92% (2/104). Conclusion The right thoracic esophagectomy and three regional lymph node dissection is the treatment of cervical and thoracic esophageal cancer more effective hand?