CAJ | 학술논문

目的研究胸段食管癌淋巴结转移规律,探讨术后预防性照射范围和适应证.方法选择行根治性切除、胸腹2个野淋巴结清扫术的胸段食管癌229例,分析不同病变部位淋巴结转移主要方式和转移规律,探讨不同病变长度和病理学分期对淋巴结转移度的影响,为胸段食管癌术后预防性照射范围和适应证选择提供参考.结果胸上段食管癌局部转移达57.1%;胸中段食管癌局部转移、跳跃转移、上行转移、下行转移和双向转移分别为39.0%、19.5%、5.2%、28.6%和7.8%;胸下段食管癌下行转移占72.2%.上纵隔、中纵隔、下纵隔和腹部淋巴结转移度胸上段食管癌分别为19.0%、6.7%、9.8%和14.3%(x2:2.75,P=0.433),胸中段食管癌分别为26.1%、7.4%、11.8%和11.9%(x2=17.98,P=0.000),胸下段食管癌分别为0%、1.6%、5.3%和10.0%(x2=5.96,P=0.051).食管癌标本病变长度≤3、>3～5、>5 cm组淋巴结转移度分别为9.1%、11.6%、11.7%(x2=3.93,P=0.140).Ⅲ期食管癌淋巴结转移度为19.3%,明显高于0～Ⅱ期的4.8%(x2=131.06,P=0.000).结论胸段食管癌淋巴结转移情况极为复杂且较为广泛,胸上和胸中段食管癌大野照射有一定理论依据,上纵隔应为重点照射区域;而胸下段食管癌似乎可适当缩小照射范围.Ⅲ期患者淋巴结转移度较高,是术后预防性照射的主要适应证.
목적 연구흉단식관암림파결전이규률,탐토술후예방성조사범위화괄응증.방법 선택행근치성절제、흉복2개야림파결청소술적흉단식관암229례,분석불동병변부위림파결전이주요방식화전이규률,탐토불동병변장도화병이학분기대림파결전이도적영향,위흉단식관암술후예방성조사범위화괄응증선택제공삼고.결과 흉상단식관암국부전이체57.1%;흉중단식관암국부전이、도약전이、상행전이、하행전이화쌍향전이분별위39.0%、19.5%、5.2%、28.6%화7.8%;흉하단식관암하행전이점72.2%.상종격、중종격、하종격화복부림파결전이도흉상단식관암분별위19.0%、6.7%、9.8%화14.3%(x2:2.75,P=0.433),흉중단식관암분별위26.1%、7.4%、11.8%화11.9%(x2=17.98,P=0.000),흉하단식관암분별위0%、1.6%、5.3%화10.0%(x2=5.96,P=0.051).식관암표본병변장도≤3、>3～5、>5 cm조림파결전이도분별위9.1%、11.6%、11.7%(x2=3.93,P=0.140).Ⅲ기식관암림파결전이도위19.3%,명현고우0～Ⅱ기적4.8%(x2=131.06,P=0.000).결론 흉단식관암림파결전이정황겁위복잡차교위엄범,흉상화흉중단식관암대야조사유일정이론의거,상종격응위중점조사구역;이흉하단식관암사호가괄당축소조사범위.Ⅲ기환자림파결전이도교고,시술후예방성조사적주요괄응증.
Objective To study the pattern of lymphatic metastasis in patients with thoracic esopha-geal carcinoma, and to determine the indication and the target volume for post-operative radiotherapy. Meth-ods 229 patients with thoracic esophageal carcinoma who had undergone radical esophagectomy and two-field lymph node dissection were included in this study. The pattern and ratio of lymph node metastasis were analyzed. The effect of the tumor length and pathology stage on lymph node metastasis was studied. Then the indication and target of post-operative radiotherapy for the thoracic esophageal carcinoma was determined. Results Regional lymph node metastasis was found in 57.1% patients with upper thoracic esophageal car-cinoma. For the middle thoracic esophageal carcinoma, the ratio of regional metastasis, skip, upward, down-ward and two-way spread were 39.0%, 19.5% ,5.2% ,28.6% and 7.8% ,respectively. For lower thoracic esophageal carcinoma,downward spread was found in 77.2% patients. For upper thoracie esophageal carci-noma,the proportions of patients with lymph node metastasis were 19.0% ,6.7% ,9.8% and 14.3% in the superior mediastinum, middle mediastinum, inferior mediastinum and abdominal cavity ( x2 = 2.75, P = 0.433). The corresponding figures were 26.1% ,7.4% ,11.8% and 11.9% (x2 = 17.98,P =0.000) for middle thoracic esophageal carcinoma,and 0%, 1.6% ,5.3% and 10.0% (x2= 5.96 ,P = 0. 051 ) for low-er thoracic esophageal carcinoma. The lymph node metastasis ratios were 9.1%, 11.6% and 11.7% in pa-tients with tumor ≤3 cm,3-5 cm and ≥5 cm,respectively (x2 =3.93,P=0. 140), and were much higher in stage Ⅲ disease than those in stage 0 to Ⅱ (19.3% vs4.8% ;x2 =131.06,P=0.000). Conclusions he pattern of lymph node metastasis is complex and extensive in patients with thoracic esophageal carcinoma. For upper and middle thoracic esophageal carcinoma, the extended prophylactic portal is suggested and the superior mediastinum is an important target area. For the lower thoracic esophageal carcinoma,it seems that regional fields could be applied. Post-operative radiotherapy should be performed in stage Ⅲ disease because of the high lymph node metastasis ratio.