中华胃肠外科杂志
中華胃腸外科雜誌
중화위장외과잡지
CHINESE JOURNAL OF GASTROINTESTINAL SURGERY
2011年
9期
711-714
,共4页
李斌%相加庆%张亚伟%胡鸿%马龙飞%缪珑昇%李鹤成%陈海泉
李斌%相加慶%張亞偉%鬍鴻%馬龍飛%繆瓏昇%李鶴成%陳海泉
리빈%상가경%장아위%호홍%마룡비%무롱승%리학성%진해천
食管肿瘤%淋巴结转移%胸部气管旁淋巴结
食管腫瘤%淋巴結轉移%胸部氣管徬淋巴結
식관종류%림파결전이%흉부기관방림파결
Esophageal neoplasms%Lymph node metastases%Paratracheal lymph nodes
目的探讨食管癌淋巴结转移情况及其危险因素，为外科手术行淋巴结清扫提供参考。方法 回顾总结2006年1月至2010年12月在复旦大学附属肿瘤医院胸外科行三野淋巴结清扫食管癌根治术308例患者的临床资料，分析淋巴结的转移规律及特点。结果308例患者平均清扫淋巴结（35.6±14.5）枚，197例(64％)患者出现淋巴结转移。Logistic单因素分析结果显示，脉管（淋巴管及血管）侵犯（P=0.019）及肿瘤浸润深度（P＜0.001）是发生淋巴结转移的危险因素。各站淋巴结中，胸部气管旁淋巴结转移率最高(25.0％)。上段食管癌腹部淋巴结转移率显著低于中段或下段食管癌(P=0.001),而各段食管癌颈胸部淋巴结转移率比较，差异无统计学意义(P＞0.05)。颈胸部和颈胸腹部淋巴结转移率分别为14.6％和11.0％,而颈腹部和胸腹部则分别为3.6％和4.9％。脉管侵犯(P＜0.001)和胸部气管旁淋巴结转移(P=0.014)是食管癌发生颈部淋巴结转移的危险因素。结论食管癌淋巴结转移具有上、下双向和跳跃性的特点，胸部气管旁淋巴结转移可作为行颈部淋巴结清扫的指征。
目的探討食管癌淋巴結轉移情況及其危險因素，為外科手術行淋巴結清掃提供參攷。方法 迴顧總結2006年1月至2010年12月在複旦大學附屬腫瘤醫院胸外科行三野淋巴結清掃食管癌根治術308例患者的臨床資料，分析淋巴結的轉移規律及特點。結果308例患者平均清掃淋巴結（35.6±14.5）枚，197例(64％)患者齣現淋巴結轉移。Logistic單因素分析結果顯示，脈管（淋巴管及血管）侵犯（P=0.019）及腫瘤浸潤深度（P＜0.001）是髮生淋巴結轉移的危險因素。各站淋巴結中，胸部氣管徬淋巴結轉移率最高(25.0％)。上段食管癌腹部淋巴結轉移率顯著低于中段或下段食管癌(P=0.001),而各段食管癌頸胸部淋巴結轉移率比較，差異無統計學意義(P＞0.05)。頸胸部和頸胸腹部淋巴結轉移率分彆為14.6％和11.0％,而頸腹部和胸腹部則分彆為3.6％和4.9％。脈管侵犯(P＜0.001)和胸部氣管徬淋巴結轉移(P=0.014)是食管癌髮生頸部淋巴結轉移的危險因素。結論食管癌淋巴結轉移具有上、下雙嚮和跳躍性的特點，胸部氣管徬淋巴結轉移可作為行頸部淋巴結清掃的指徵。
목적탐토식관암림파결전이정황급기위험인소，위외과수술행림파결청소제공삼고。방법 회고총결2006년1월지2010년12월재복단대학부속종류의원흉외과행삼야림파결청소식관암근치술308례환자적림상자료，분석림파결적전이규률급특점。결과308례환자평균청소림파결（35.6±14.5）매，197례(64％)환자출현림파결전이。Logistic단인소분석결과현시，맥관（림파관급혈관）침범（P=0.019）급종류침윤심도（P＜0.001）시발생림파결전이적위험인소。각참림파결중，흉부기관방림파결전이솔최고(25.0％)。상단식관암복부림파결전이솔현저저우중단혹하단식관암(P=0.001),이각단식관암경흉부림파결전이솔비교，차이무통계학의의(P＞0.05)。경흉부화경흉복부림파결전이솔분별위14.6％화11.0％,이경복부화흉복부칙분별위3.6％화4.9％。맥관침범(P＜0.001)화흉부기관방림파결전이(P=0.014)시식관암발생경부림파결전이적위험인소。결론식관암림파결전이구유상、하쌍향화도약성적특점，흉부기관방림파결전이가작위행경부림파결청소적지정。
Objective To investigate the status of lymph node metastases (LNM) of esophageal carcinoma and to identify the risk factors. Methods Clinical data of 308 patients who underwent esophagectomy with three-field lymphadenectomy during January 2006 and December 2010 were reviewed. Characteristics of LNM were studied. Results The average number of dissected lymph nodes was 35.6±14.5 in 308 patients. There were 197 patients (64％) had LNM. Logistic regression analysis showed that lymphatic vessel invasion(P=0.019) and deep tumor invasion(P＜0.001 ) were risk factors of LNM. The highest LNM site was paratracheal node (25.0％). The incidence of cervical LNM was 14.1％ in the middle thoracic carcinoma, higher than that of upper thoracic (7.3％) and lower thoracic (8.3％). Rate of LNM was lower in upper thoracic carcinomas than that in middle or lower ones (P=0.001). No significant difference of LNM was found among upper, middle and lower thoracic carcinoma for cervical or thoracic nodes. Lymphatic vessel invasion (P＜0.001)and metastases in paratracheal lymph nodes (P=0.014) were risk factors for cervical LNM. Conclusions LNM of esophageal carcinoma can be found in both directions vertically and skipped metastasis. Paratracheal lymph nodes involvement is an indicator for cervical lymphadenectomy in thoracic esophageal carcinoma.
