中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2009年
14期
4-6
,共3页
宋庆青%刘文峰%李可志%占新庆%张荣良
宋慶青%劉文峰%李可誌%佔新慶%張榮良
송경청%류문봉%리가지%점신경%장영량
食管肿瘤%淋巴转移%颈淋巴结清扫术%超声检查%体层摄影术,X线计算机
食管腫瘤%淋巴轉移%頸淋巴結清掃術%超聲檢查%體層攝影術,X線計算機
식관종류%림파전이%경림파결청소술%초성검사%체층섭영술,X선계산궤
Esophageal neoplasms%Lymphatic metastasis%Neck dissection%Ultrasonography%Tomography,X-ray computed
目的 探讨胸段食管癌下颈部淋巴结转移规律,评价合理的淋巴结清扫范围.方法 108例胸段食管癌患者术前应用彩色超声加CT对下颈部进行探查,有选择地分为三野淋巴结清扫(三野组)31例,二野淋巴结清扫(二野组)77例.结果 三野组手术死亡1例,术后并发症发生率41.9%(13131),高于二野组的18.2%(14/77)(P<0.05);胸上段食管癌下颈部淋巴结转移率47.6%(10/21),高于胸中段的21.3%(13/61)及胸中、下段的19.5%(17/87)(P<0.05);胸上段食管癌行i野淋巴结清扫占57.1%(12/21),高于胸中段的23.0%(14/61)及胸中、下段的21.8%(19/87)(P<0.05);三野组3年生存率46.2%(6/13),二野组42.9%(15/35)(P>0.05).结论 胸段食管癌下颈部淋巴结转移以区域性转移为主;术前应用彩色超声加CT判断下颈部淋巴结有无转移的方法是可行的;胸上段食管癌主张行二野淋巴结清扫,胸中、下段食管癌则视彩色超声加CT对下颈部的探查结果,有选择地行三野淋巴结清扫.
目的 探討胸段食管癌下頸部淋巴結轉移規律,評價閤理的淋巴結清掃範圍.方法 108例胸段食管癌患者術前應用綵色超聲加CT對下頸部進行探查,有選擇地分為三野淋巴結清掃(三野組)31例,二野淋巴結清掃(二野組)77例.結果 三野組手術死亡1例,術後併髮癥髮生率41.9%(13131),高于二野組的18.2%(14/77)(P<0.05);胸上段食管癌下頸部淋巴結轉移率47.6%(10/21),高于胸中段的21.3%(13/61)及胸中、下段的19.5%(17/87)(P<0.05);胸上段食管癌行i野淋巴結清掃佔57.1%(12/21),高于胸中段的23.0%(14/61)及胸中、下段的21.8%(19/87)(P<0.05);三野組3年生存率46.2%(6/13),二野組42.9%(15/35)(P>0.05).結論 胸段食管癌下頸部淋巴結轉移以區域性轉移為主;術前應用綵色超聲加CT判斷下頸部淋巴結有無轉移的方法是可行的;胸上段食管癌主張行二野淋巴結清掃,胸中、下段食管癌則視綵色超聲加CT對下頸部的探查結果,有選擇地行三野淋巴結清掃.
목적 탐토흉단식관암하경부림파결전이규률,평개합리적림파결청소범위.방법 108례흉단식관암환자술전응용채색초성가CT대하경부진행탐사,유선택지분위삼야림파결청소(삼야조)31례,이야림파결청소(이야조)77례.결과 삼야조수술사망1례,술후병발증발생솔41.9%(13131),고우이야조적18.2%(14/77)(P<0.05);흉상단식관암하경부림파결전이솔47.6%(10/21),고우흉중단적21.3%(13/61)급흉중、하단적19.5%(17/87)(P<0.05);흉상단식관암행i야림파결청소점57.1%(12/21),고우흉중단적23.0%(14/61)급흉중、하단적21.8%(19/87)(P<0.05);삼야조3년생존솔46.2%(6/13),이야조42.9%(15/35)(P>0.05).결론 흉단식관암하경부림파결전이이구역성전이위주;술전응용채색초성가CT판단하경부림파결유무전이적방법시가행적;흉상단식관암주장행이야림파결청소,흉중、하단식관암칙시채색초성가CT대하경부적탐사결과,유선택지행삼야림파결청소.
Objective To study the rule of lower-cervical lymphatic metastasis in thoracic esophageal carcinoma,and make evaluation about the reasonable extent of lymphadenectomy. Methods One hundred and eight cases of thoracic esophageal carcinoma through chromatic ultrasound and CT before operation were divided into different groups selectively,while three fields lymphadenectomy (3-FL) was adopted in 31 cases,and two fields lymphadenctomy (2-FL) was adopted in 77 cases. Results The rate of lower-cervical lymphatic metastasis was 87.1%(27/31) through chromatic ultrasound and CT,and that was 25.0%(27/108) before the two up-mentioned examinations (P<0.05). In all cases, the rate of lower-cervical lymphatic metastasis in the upper pectoral esophageal carcinoma was 47.6% (10/21),that in the middle pectoral esophageal carcinoma was 21.3%(13161),and that in the middle and lower pectoral esophageal carcinoma was 19.5%(17187) ,P<0.05. Through 3-FL, the rate of lower--cervical lymphatic metastasis in the upper pectoral esophageal eareinoma was 57.1%(12/21), that in the middle pectoral esophageal carcinoma was 23.0%(14/61), and that in the middle and lower pectoral esophageal carcinoma was 21.8%(19/87), P<0.05. Conclusions The regionality metastasis is the main fashion in thoracic esophageal carcinoma with lower-cervical lymphatic metastasis. It is feasible to judge lower-cervical lymphatic metastasis through chromatic ultrasound and CT before operation.The 3-FL of the upper pectoral esophageal carcinoma is recommended. The 3-FL is selectable in the middle and lower pectoral esophageal carcinoma according to the result of chromatic ultrasound and CT.
