肿瘤研究与临床
腫瘤研究與臨床
종류연구여림상
CANCER RESEARCH AND CLINIC
2013年
2期
77-79
,共3页
伍宁%陈志明%庞烈文%马勤运%陈刚
伍寧%陳誌明%龐烈文%馬勤運%陳剛
오저%진지명%방렬문%마근운%진강
食管肿瘤%淋巴结转移%淋巴结切除术
食管腫瘤%淋巴結轉移%淋巴結切除術
식관종류%림파결전이%림파결절제술
Esophageal carcinoma%Lymph node metastasis%Lymphadenectomy
目的 比较左胸单切口和颈-右胸-腹三切口在食管癌根治手术中的淋巴结清扫情况,探讨食管癌手术中合理的淋巴结切除范围.方法 回顾性分析2006年1月至2008年1月行食管癌根治手术的95例患者的临床资料,根据手术方式分为左胸切口组62例和三切口组33例,对淋巴结清扫状况和术后并发症进行分析.结果 95例患者共切除1322枚淋巴结,平均每例切除13.9枚.95例中有43例(45.3％)出现淋巴结转移.左胸切口组和三切口组淋巴结转移率分别为40.3％(25/62)和54.5％(18/33).上段和中段食管癌的颈部淋巴结转移率分别为25.0％(2/8)和40.0％(4/10),下段食管癌的腹部淋巴结转移率为53.8 ％(7/13).食管癌的浸润深度(r=0.315,P=0.007)和分化程度(r=0.239,P=0.017)与淋巴结转移显著相关.肿瘤长度＞2 cm时淋巴结转移率明显增高(x2=34.2,P＜ 0.001).左胸切口组和三切口组患者术后并发症发生率分别为25.8％(16/62)和4.2％(8/33),差异无统计学意义(x2=0.017,P=0.869).围手术期死亡率分别为1.6％(1/62)和3.0％(1/33),差异无统计学意义(x2=0.047,P=0.651).结论 食管癌根治手术应综合考虑肿瘤浸润深度、分化程度和长度对淋巴结转移的影响.对于上、中段食管癌宜选择三切口利于行术野淋巴结切除,下段食管癌应重视腹腔淋巴结的切除.
目的 比較左胸單切口和頸-右胸-腹三切口在食管癌根治手術中的淋巴結清掃情況,探討食管癌手術中閤理的淋巴結切除範圍.方法 迴顧性分析2006年1月至2008年1月行食管癌根治手術的95例患者的臨床資料,根據手術方式分為左胸切口組62例和三切口組33例,對淋巴結清掃狀況和術後併髮癥進行分析.結果 95例患者共切除1322枚淋巴結,平均每例切除13.9枚.95例中有43例(45.3％)齣現淋巴結轉移.左胸切口組和三切口組淋巴結轉移率分彆為40.3％(25/62)和54.5％(18/33).上段和中段食管癌的頸部淋巴結轉移率分彆為25.0％(2/8)和40.0％(4/10),下段食管癌的腹部淋巴結轉移率為53.8 ％(7/13).食管癌的浸潤深度(r=0.315,P=0.007)和分化程度(r=0.239,P=0.017)與淋巴結轉移顯著相關.腫瘤長度＞2 cm時淋巴結轉移率明顯增高(x2=34.2,P＜ 0.001).左胸切口組和三切口組患者術後併髮癥髮生率分彆為25.8％(16/62)和4.2％(8/33),差異無統計學意義(x2=0.017,P=0.869).圍手術期死亡率分彆為1.6％(1/62)和3.0％(1/33),差異無統計學意義(x2=0.047,P=0.651).結論 食管癌根治手術應綜閤攷慮腫瘤浸潤深度、分化程度和長度對淋巴結轉移的影響.對于上、中段食管癌宜選擇三切口利于行術野淋巴結切除,下段食管癌應重視腹腔淋巴結的切除.
목적 비교좌흉단절구화경-우흉-복삼절구재식관암근치수술중적림파결청소정황,탐토식관암수술중합리적림파결절제범위.방법 회고성분석2006년1월지2008년1월행식관암근치수술적95례환자적림상자료,근거수술방식분위좌흉절구조62례화삼절구조33례,대림파결청소상황화술후병발증진행분석.결과 95례환자공절제1322매림파결,평균매례절제13.9매.95례중유43례(45.3％)출현림파결전이.좌흉절구조화삼절구조림파결전이솔분별위40.3％(25/62)화54.5％(18/33).상단화중단식관암적경부림파결전이솔분별위25.0％(2/8)화40.0％(4/10),하단식관암적복부림파결전이솔위53.8 ％(7/13).식관암적침윤심도(r=0.315,P=0.007)화분화정도(r=0.239,P=0.017)여림파결전이현저상관.종류장도＞2 cm시림파결전이솔명현증고(x2=34.2,P＜ 0.001).좌흉절구조화삼절구조환자술후병발증발생솔분별위25.8％(16/62)화4.2％(8/33),차이무통계학의의(x2=0.017,P=0.869).위수술기사망솔분별위1.6％(1/62)화3.0％(1/33),차이무통계학의의(x2=0.047,P=0.651).결론 식관암근치수술응종합고필종류침윤심도、분화정도화장도대림파결전이적영향.대우상、중단식관암의선택삼절구리우행술야림파결절제,하단식관암응중시복강림파결적절제.
Objective To explore the extent of lymphadenectomy by comparing the single left thoracotomy and cervico-right thoracic-abdominal triple incision during esophageal carcinoma radial surgery.Methods The clinical data of 95 patients with thoracic esophageal carcinoma underwent esophagectomy plus lymphadenectomy were studied.They were divided into two groups,left thoracotomy group(62 cases)and triple incision group(33 cases).The rates of lymph node metastasis and postoperative complications were analyzed statistically.Results A total of 1322 lymph nodes were dissected with an average of 13.9 lymph nodes in each case.The rates of lymph node metastasis were 45.3 ％(43/95)of all patients,40.3 ％ of left thoracotomy and 54.5 ％ of triple incision.The rates of lymph node metastasis in the neck for patients with upper or middle thoracic esophageal carcinoma were 25.0 ％(2/8)and 40.0 ％(4/10).The rate of abdominal lymph node metastasis was 53.8 ％(7/13)in lower thoracic carcinoma.The depth of tumor invasion (r =0.315,P =0.007)and tumor differentiation(r =0.239,P =0.017)were correlated to lymph node metastasis.Patients with tumor length ＞2 cm had higher rates of lymph node metastasis(x2 =34.2,P ＜ 0.001).The postoperative complication rates of left thoracotomy and triple incision were 25.8 ％(16/62)and 4.2 ％ (8/33).The mortalities rates of left thoracotomy and triple incision were 1.6 ％(1/62)and 3.0 ％(1/33).There was no significant difference in postoperative complication rates(x2 =0.017,P =0.869)and mortalities rates(x2 =0.047,P =0.651)between the two groups.Conclusion Tumor invasion,differentiation and length should be incorporated in the evaluation of lymph node status.Patients with upper and middle thoracic esophageal carcinoma should receive cervico-right thoracic-abdominal triple incision.Particular attention should be given to the resection of abdominal lymph nodes in patients with lower thoracic esophageal carcinoma.
