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目的探讨胸段食管癌淋巴结转移规律及其对淋巴结清扫方式的影响。方法对接受三野淋巴结清扫的230例食管鳞癌病人的肿瘤部位、临床病理指标与淋巴结转移的关系进行分析。结果每例病人的淋巴结切除11～71枚,平均(25.3±11.4)枚。其中133例病人存在区域淋巴结转移。颈、胸和腹三区淋巴结转移率,上胸段食管癌为41.6%、19.44%和8.3%,中胸段食管癌为33.3%、34.7%和14%,下胸段食管癌为36.4%、34.1%和43.2%。上、中、下胸段食管癌颈部或胸腔淋巴结转移率差异无统计学意义,下胸段食管癌腹腔淋巴结转移率显著高于上胸段或中胸段食管癌。Logistic 回归模型显示肿瘤浸润深度和淋巴管血管浸润情况是影响淋巴结转移的有意义因素。结论对各胸段食管癌均应清扫颈、胸部淋巴结,上、中胸段食管癌腹部淋巴结清扫的意义尚需进一步研究。病人的肿瘤浸润深度及有无淋巴血管浸润与淋巴结是否转移密切相关。
Objective To investigate the rule of lymph node metastasis in thoracic esophageal cancer and its effect on the lymph node dissection. Methods 230 cases of esophageal squamous cell carcinoma who underwent three-node lymphadenectomy were analyzed the relationship between tumor location, clinicopathological parameters and lymph node metastasis. Results Each patient’s lymph node resection 11 to 71, an average of (25.3 ± 11.4) pieces. 133 cases of patients with regional lymph node metastasis. The rates of lymph node metastasis were 41.6%, 19.44% and 8.3% in upper thoracic esophagus, 33.3%, 34.7% and 14% in middle thoracic esophagus, 36.4% in lower thoracic esophagus, 34.1% and 43.2%. There was no significant difference in the lymph node metastasis rate of the upper thoracic, middle thoracic thoracic esophageal cancer and thoracic esophageal cancer, and the lymph node metastasis rate of the lower thoracic esophageal cancer was significantly higher than that of the upper thoracic esophageal cancer or the middle thoracic esophageal cancer. Logistic regression model showed that the depth of tumor invasion and vascular invasion of lymphatic vessels is a significant factor affecting lymph node metastasis. Conclusions The significance of lymph node dissection in the thoracic esophageal carcinoma of the neck and thoracic lymph nodes, upper and middle thoracic esophageal cancer should be further studied. The depth of tumor invasion and the presence or absence of lymphatic vessel invasion and lymph node metastasis are closely related.