CAJ | 학술논문

目的探讨食管癌切除现代二野淋巴结清扫的手术疗效及临床实际应用价值.方法 1987年6月至2007年12月间,对1690例中下段及上段食管癌患者分别采用Ivor-Lewis术式和Akiyama术式进行现代淋巴结清扫治疗,总结胸腹二野淋巴结转移的发生率以及患者术后1、3、5和10年的生存率.结果全组患者中,有淋巴结转移713例,转移率为42.2%(713/1690).胸部淋巴结转移665例,占39.3%(665/1690),其中有胸顶气管旁三角区淋巴结转移349例,占20.7%;后上纵隔淋巴结转移444例,占26.3%;下纵隔淋巴结转移307例,占18.2%.腹部淋巴结转移339例,占20.1%.全组患者术后有278例发生312例次各种并发症,并发症的发生率为16.4%(278/1690),其中以肺部并发症为主,共136例次,占43.6%.全组患者的手术死亡率为0.2%.全组患者术后1、3、5和10年生存率分别为88.2%(1388/1574)、63.5%(868/1367)、54.8%(705/1287)和30.8%(232/754).无淋巴结转移患者的5年生存率为76.2%(448/588),有淋巴结转移患者的5年生存率为36.8%(257/699).结论食管癌切除采用Ivor-Lewis和Akiyama术式可良好地显露胸腹二野,淋巴结清扫彻底,特别是对后上纵隔喉返神经旁、右胸顶气管旁三角区淋巴结的清扫尤为便利.对有淋巴结转移的食管癌患者施行现代二野淋巴结清扫十分必要,能显著提高患者的术后5年生存率.
목적 탐토식관암절제현대이야림파결청소적수술료효급림상실제응용개치.방법 1987년6월지2007년12월간,대1690례중하단급상단식관암환자분별채용Ivor-Lewis술식화Akiyama술식진행현대림파결청소치료,총결흉복이야림파결전이적발생솔이급환자술후1、3、5화10년적생존솔.결과 전조환자중,유림파결전이713례,전이솔위42.2%(713/1690).흉부림파결전이665례,점39.3%(665/1690),기중유흉정기관방삼각구림파결전이349례,점20.7%;후상종격림파결전이444례,점26.3%;하종격림파결전이307례,점18.2%.복부림파결전이339례,점20.1%.전조환자술후유278례발생312례차각충병발증,병발증적발생솔위16.4%(278/1690),기중이폐부병발증위주,공136례차,점43.6%.전조환자적수술사망솔위0.2%.전조환자술후1、3、5화10년생존솔분별위88.2%(1388/1574)、63.5%(868/1367)、54.8%(705/1287)화30.8%(232/754).무림파결전이환자적5년생존솔위76.2%(448/588),유림파결전이환자적5년생존솔위36.8%(257/699).결론 식관암절제채용Ivor-Lewis화Akiyama술식가량호지현로흉복이야,림파결청소철저,특별시대후상종격후반신경방、우흉정기관방삼각구림파결적청소우위편리.대유림파결전이적식관암환자시행현대이야림파결청소십분필요,능현저제고환자적술후5년생존솔.
Objective To summarize the surgical effect and clinical application value of esophagectomy with extended 2-field lymph node dissection for patients with esophageal carcinoma. Methods From June 1987 to December 2008, 1690 patients with esophageal cancer underwent esophagectomy with extended 2-field (thoracic and abdominal) dissection of lymph nodes. Patients with the middle and lower thoracic esophageal cancer underwent Ivor-Lewis esophageetomy, and patients with upper thoracic esophageal cancer underwent Akiyama esophagectomy. 2-field (thoracic and abdominal ) lymph node metastases information and the 1, 3, 5, 10-year survival rates were analyzed retrospectively. Results Lymph node metastases were found in 713 patients. The lymph node metastases rate was 42.2% (713/1690). Thoracic lymph node metastasis rate was 39.3% (665/1690), among which in the fight pleural apical pars-tracheal triangle was 20.7% (349/1690), in the posterior upper mediastinum was 26.3% (444/1690), in the lower mediastinum was 18.2% (307/1690). Abdominal lymph node metastasis rate was 20. 1% (339/1690). THE Postoperative complication rate was 16.4% ( 278/1690 ), among which the pulmonary complication rate ranking the first, was 43.6% (136/312). The operative mortality rate was 0.2%. The 1- year, 3-year, 5-year and 10-year survival rates were 88.2% (1388/1574), 63.5% (868/1367), 54.8% (705/1287) and 30.8% (232/754), respectively. The 5-year survival rate in patients without lymph node metastasis was 76.2% (448/588), but that in patients with lymph node metastases was 36.8% (257/669). Conclusion The results of this study demonstrated that Ivor-Lewis and Akiyama esophagectomy with two-field lymph node dissection exposes the operation fields clearly and make radical lymphadenectomy thoroughly, especially the lymph nodes in the posterior upper mediastinum around the recurrent laryngeal nerve and in the right pleural apical para-tracheal triangle. It is essential that patients with esophageal carcinoma with lymph node metastases should undergo esophageetomy with extended 2-field dissection of lymph nodes. This can elevate the postoperative 5-year survival rate remarkably.