CAJ | 학술논문

目的：探讨手术重点清扫淋巴结的临床病理特点及预后，为规范化清扫提供参考。方法对515例胸段食管癌手术患者的临床资料进行分析，重点研究隆突下、食管旁、胃左动脉旁三组重点清扫淋巴结与临床病理因素间的单因素和多因素分析及预后情况。结果单因素和多因素分析显示：隆突下淋巴结转移与肿瘤长度、分化程度和浸润深度有关（P＜0.05）；食管旁淋巴结转移与肿瘤浸润深度有关（P＜0.05）；胃左动脉旁淋巴结转移与肿瘤部位、分化程度和浸润深度有关（P＜0.05）。生存分析显示：在N1～3患者，食管旁、胃左动脉旁淋巴结的清扫组与未清扫组相比，其1、3、5年生存率均有显著差异（P＜0.05）。结论胸段食管癌应尽可能对转移率较高的食管旁和胃左动脉旁淋巴结清扫彻底。对病变侵及食管全层或病变长度＞3 cm的患者应常规实施隆突下淋巴结的彻底清扫。在N1～3患者中，行食管旁、胃左动脉旁淋巴结清扫能提高患者的生存率。
목적：탐토수술중점청소림파결적림상병리특점급예후，위규범화청소제공삼고。방법대515례흉단식관암수술환자적림상자료진행분석，중점연구륭돌하、식관방、위좌동맥방삼조중점청소림파결여림상병리인소간적단인소화다인소분석급예후정황。결과단인소화다인소분석현시：륭돌하림파결전이여종류장도、분화정도화침윤심도유관（P＜0.05）；식관방림파결전이여종류침윤심도유관（P＜0.05）；위좌동맥방림파결전이여종류부위、분화정도화침윤심도유관（P＜0.05）。생존분석현시：재N1～3환자，식관방、위좌동맥방림파결적청소조여미청소조상비，기1、3、5년생존솔균유현저차이（P＜0.05）。결론흉단식관암응진가능대전이솔교고적식관방화위좌동맥방림파결청소철저。대병변침급식관전층혹병변장도＞3 cm적환자응상규실시륭돌하림파결적철저청소。재N1～3환자중，행식관방、위좌동맥방림파결청소능제고환자적생존솔。
Objective To study the clinicopathologic characteristic and prognosis status and provide the references for standard lymphadenectomy.MethodsThe clinical data of 515 patients with thoracic esophageal carcinoma were analyzed to get knowledge of the relationship between lymphadenectomy and clinicopathologic characteristic and prognosis status in subcarinal, para-esophageal and left gastric artery.Results Univariate and multivariate analysis showed that subcarinal lymph node metastasis was significantly associated with tumor size, degree of differentiation and depth of invasion (P<0.05). The para-esophageal lymph node metastasis was significantly associated with depth of invasion and left gastric artery lymph node metastasis was also significantly associated with tumor location, tumor differentiation and depth of invasion (P<0.05). For N1-N3 patients, the survival analysis showed that there was obvious difference in one-year, three-year and five-year survival rate between patients who conducted lymphadenectomy of para-esophagus, left gastric artery and patients who did not perform those. Conclusions Because of their high metastasis rate, thoracic esophageal carcinoma should be conducted lymphadenectomy in para-esophagus and left gastric artery as far as possible. The subcarinal lymphadenectomy should be conducted in patients who’s full thickness of esophageal have been invaded or l who's lesion length >3 cm. For patients with N1-N3, conducting lymphadenectomy of para-esophagus, left gastric artery could improve the survival rate of patients with thoracic esophageal carcinoma.