CAJ | 학술논문

目的分析胸段食管癌隆突下淋巴结的转移状况及规律,探讨隆突下淋巴结规范化清扫的策略.方法回顾性分析782例胸段食管癌患者隆突下淋巴结的转移状况与临床病理因素的关系,并进一步分析清扫隆突下淋巴结对围手术期并发症的影响.结果 782例患者中,有604例(77.2％)患者术中予以隆突下淋巴结清扫,食管癌隆突下淋巴结总的转移率为17.5％,其中上、中、下段食管癌隆突下淋巴结的转移率分别为8.3％、19.1％和16.2％ (P ＞0.05).T1、T2、T3和T4期肿瘤的隆突下淋巴结转移率分别为0、4.0％、22.2％和34.0％ (P ＜0.05).隆突下淋巴结清扫组和未清扫组患者围手术期并发症的总发生率分别为19.0％和14.6％ (P ＞0.05),其中肺部并发症发生率分别为10.3％和7.3％(P＞0.05).结论胸段食管癌有较高的隆突下淋巴结转移率,但隆突下淋巴结清扫与否与围手术期并发症无明显关系.对于胸段食管癌患者,无论肿瘤部位、长度及大小,只要侵犯食管外膜,都应该常规清扫隆突下淋巴结.
목적 분석흉단식관암륭돌하림파결적전이상황급규률,탐토륭돌하림파결규범화청소적책략.방법 회고성분석782례흉단식관암환자륭돌하림파결적전이상황여림상병리인소적관계,병진일보분석청소륭돌하림파결대위수술기병발증적영향.결과 782례환자중,유604례(77.2％)환자술중여이륭돌하림파결청소,식관암륭돌하림파결총적전이솔위17.5％,기중상、중、하단식관암륭돌하림파결적전이솔분별위8.3％、19.1％화16.2％ (P ＞0.05).T1、T2、T3화T4기종류적륭돌하림파결전이솔분별위0、4.0％、22.2％화34.0％ (P ＜0.05).륭돌하림파결청소조화미청소조환자위수술기병발증적총발생솔분별위19.0％화14.6％ (P ＞0.05),기중폐부병발증발생솔분별위10.3％화7.3％(P＞0.05).결론 흉단식관암유교고적륭돌하림파결전이솔,단륭돌하림파결청소여부여위수술기병발증무명현관계.대우흉단식관암환자,무론종류부위、장도급대소,지요침범식관외막,도응해상규청소륭돌하림파결.
Objective To assess the metastatic frequency of subcarinal lymph nodes of thoracic esophageal carcinoma and its influencing factors,in order to determine the adequate range of lymph node dissection during esophagectomy.Methods The clinical data from a cohort of 782 patients with thoracic esophageal carcinoma who underwent esophagectomy with lymphadenectomy were analyzed retrospectively with respect to the impact of subcarinal lymph nodes dissection or no dissection on the incidence of postoperative complications.Results The metastasis rate of subcarinal lymph nodes was 17.5％.The metastasis rates in the upper,middle and lower esophageal carcinomas were 8.3％,19.1％ and 16.2％,respectively (P ＞0.05).For T1,T2,T3 and T4,they were 0,4％,22.2％ and 34％,respectively (P ＜ 0.05).The overall incidence of postoperative complications with and without subcarinal lymph nodes dissection was 19.0％ versus 14.6％ (P ＞ 0.05),and the incidence of pulmonary complications was 10.3％ versus 7.3％ (P ＞ 0.05).Conclusions Thoracic esophageal carcinomas have a high metastasis rate of subcrinal lymph nodes,and subcarinal lymph nodes dissection is not associated with increasing perioperative complications.Therefore,for the thoracic esophageal carcinoma,no matter the tumor site,esophageal cancer length or size,once the tumor invades the outer membrane,routine subcarinal lymph node dissection should be done.