目的 分析胸段食管鳞癌中肝总淋巴结转移规律,探讨肝总淋巴结清扫的策略.方法 回顾性分析2005年5月至2010年12月复旦大学附属肿瘤医院收治的682例食管鳞癌患者的临床资料.分析胸段食管鳞癌区域淋巴结转移情况、肝总淋巴结转移率与临床病理因素的关系及患者术后近期并发症发生情况.计数资料采用x2检验.结果 682例胸段食管鳞癌患者共清扫淋巴结18 277枚,平均清扫27枚/例,淋巴结转移率为55.87％(381/682),淋巴结转移度为7.87％(1438/18 277).在所有清扫的淋巴结中,贲门旁淋巴结、喉返神经旁淋巴结、胃小弯淋巴结、颈段食管旁淋巴结、胃左动脉旁淋巴结转移率较高,而肝总淋巴结转移率最低,并且无单独肝总淋巴结转移,全部伴有区域淋巴结转移.682例患者共清扫肝总淋巴结1480枚,平均清扫2枚/例.24例患者发生肝总淋巴结转移,淋巴结转移率为3.52％ (24/682),淋巴结转移度为2.16％ (32/1480).胸上、中、下段食管鳞癌肝总淋巴结转移率分别为2.33％ (1/43)、3.76％(16/425)、3.27％(7/214),3者比较,差异无统计学意义(x2=0.295,P＞0.05)；T1、T2、T3期患者的肝总淋巴结转移率分别为2.35％(2/85)、5.46％(10/183)、2.90％(12/414),3者比较,差异无统计学意义(x2=2.850,P＞0.05)；高、中、低分化食管鳞癌患者肝总淋巴结转移率分别为0(0/63)、3.50％(16/457)、4.94％(8/162),3者比较,差异无统计学意义(x2=3.259,P＞0.05)；肿瘤直径≤3 cm、＞3 cm且≤5 cm、＞5 cm的患者肝总淋巴结转移率分别为2.59％(6/232)、3.02％ (11/364)、8.14％ (7/86),3者比较,差异有统计学意义(x2=6.267,P ＜0.05)；N分期中N0、N1、N2、N3期患者的肝总淋巴结转移率分别为0(0/301)、2.53％(5/198)、5.65％(7/124)和20.34％(12/59),4者比较,差异有统计学意义(x2=62.368,P＜0.05)；肿瘤TNM分期中Ⅰ、Ⅱ、Ⅲ、Ⅳ期患者肝总淋巴结转移率分别为0(0/62)、1.78％(6/337)、5.06％(13/257)、19.23％(5/26),4者比较,差异有统计学意义(x2=25.959,P＜0.05).228例患者术后出现并发症,并发症发生率为33.43％(228/682),其中吻合口瘘的发生率最高,发生率为11.58％(79/682).结论 胸段食管鳞癌区域淋巴结转移中肝总淋巴结转移率最低,对于Ⅰ期或者肿瘤直径≤5 cm的食管鳞癌患者,手术过程中可考虑不常规行肝总淋巴结清扫.
目的 分析胸段食管鱗癌中肝總淋巴結轉移規律,探討肝總淋巴結清掃的策略.方法 迴顧性分析2005年5月至2010年12月複旦大學附屬腫瘤醫院收治的682例食管鱗癌患者的臨床資料.分析胸段食管鱗癌區域淋巴結轉移情況、肝總淋巴結轉移率與臨床病理因素的關繫及患者術後近期併髮癥髮生情況.計數資料採用x2檢驗.結果 682例胸段食管鱗癌患者共清掃淋巴結18 277枚,平均清掃27枚/例,淋巴結轉移率為55.87％(381/682),淋巴結轉移度為7.87％(1438/18 277).在所有清掃的淋巴結中,賁門徬淋巴結、喉返神經徬淋巴結、胃小彎淋巴結、頸段食管徬淋巴結、胃左動脈徬淋巴結轉移率較高,而肝總淋巴結轉移率最低,併且無單獨肝總淋巴結轉移,全部伴有區域淋巴結轉移.682例患者共清掃肝總淋巴結1480枚,平均清掃2枚/例.24例患者髮生肝總淋巴結轉移,淋巴結轉移率為3.52％ (24/682),淋巴結轉移度為2.16％ (32/1480).胸上、中、下段食管鱗癌肝總淋巴結轉移率分彆為2.33％ (1/43)、3.76％(16/425)、3.27％(7/214),3者比較,差異無統計學意義(x2=0.295,P＞0.05)；T1、T2、T3期患者的肝總淋巴結轉移率分彆為2.35％(2/85)、5.46％(10/183)、2.90％(12/414),3者比較,差異無統計學意義(x2=2.850,P＞0.05)；高、中、低分化食管鱗癌患者肝總淋巴結轉移率分彆為0(0/63)、3.50％(16/457)、4.94％(8/162),3者比較,差異無統計學意義(x2=3.259,P＞0.05)；腫瘤直徑≤3 cm、＞3 cm且≤5 cm、＞5 cm的患者肝總淋巴結轉移率分彆為2.59％(6/232)、3.02％ (11/364)、8.14％ (7/86),3者比較,差異有統計學意義(x2=6.267,P ＜0.05)；N分期中N0、N1、N2、N3期患者的肝總淋巴結轉移率分彆為0(0/301)、2.53％(5/198)、5.65％(7/124)和20.34％(12/59),4者比較,差異有統計學意義(x2=62.368,P＜0.05)；腫瘤TNM分期中Ⅰ、Ⅱ、Ⅲ、Ⅳ期患者肝總淋巴結轉移率分彆為0(0/62)、1.78％(6/337)、5.06％(13/257)、19.23％(5/26),4者比較,差異有統計學意義(x2=25.959,P＜0.05).228例患者術後齣現併髮癥,併髮癥髮生率為33.43％(228/682),其中吻閤口瘺的髮生率最高,髮生率為11.58％(79/682).結論 胸段食管鱗癌區域淋巴結轉移中肝總淋巴結轉移率最低,對于Ⅰ期或者腫瘤直徑≤5 cm的食管鱗癌患者,手術過程中可攷慮不常規行肝總淋巴結清掃.
목적 분석흉단식관린암중간총림파결전이규률,탐토간총림파결청소적책략.방법 회고성분석2005년5월지2010년12월복단대학부속종류의원수치적682례식관린암환자적림상자료.분석흉단식관린암구역림파결전이정황、간총림파결전이솔여림상병리인소적관계급환자술후근기병발증발생정황.계수자료채용x2검험.결과 682례흉단식관린암환자공청소림파결18 277매,평균청소27매/례,림파결전이솔위55.87％(381/682),림파결전이도위7.87％(1438/18 277).재소유청소적림파결중,분문방림파결、후반신경방림파결、위소만림파결、경단식관방림파결、위좌동맥방림파결전이솔교고,이간총림파결전이솔최저,병차무단독간총림파결전이,전부반유구역림파결전이.682례환자공청소간총림파결1480매,평균청소2매/례.24례환자발생간총림파결전이,림파결전이솔위3.52％ (24/682),림파결전이도위2.16％ (32/1480).흉상、중、하단식관린암간총림파결전이솔분별위2.33％ (1/43)、3.76％(16/425)、3.27％(7/214),3자비교,차이무통계학의의(x2=0.295,P＞0.05)；T1、T2、T3기환자적간총림파결전이솔분별위2.35％(2/85)、5.46％(10/183)、2.90％(12/414),3자비교,차이무통계학의의(x2=2.850,P＞0.05)；고、중、저분화식관린암환자간총림파결전이솔분별위0(0/63)、3.50％(16/457)、4.94％(8/162),3자비교,차이무통계학의의(x2=3.259,P＞0.05)；종류직경≤3 cm、＞3 cm차≤5 cm、＞5 cm적환자간총림파결전이솔분별위2.59％(6/232)、3.02％ (11/364)、8.14％ (7/86),3자비교,차이유통계학의의(x2=6.267,P ＜0.05)；N분기중N0、N1、N2、N3기환자적간총림파결전이솔분별위0(0/301)、2.53％(5/198)、5.65％(7/124)화20.34％(12/59),4자비교,차이유통계학의의(x2=62.368,P＜0.05)；종류TNM분기중Ⅰ、Ⅱ、Ⅲ、Ⅳ기환자간총림파결전이솔분별위0(0/62)、1.78％(6/337)、5.06％(13/257)、19.23％(5/26),4자비교,차이유통계학의의(x2=25.959,P＜0.05).228례환자술후출현병발증,병발증발생솔위33.43％(228/682),기중문합구루적발생솔최고,발생솔위11.58％(79/682).결론 흉단식관린암구역림파결전이중간총림파결전이솔최저,대우Ⅰ기혹자종류직경≤5 cm적식관린암환자,수술과정중가고필불상규행간총림파결청소.
Objective To analyze the metastatic rule of common hepatic artery lymph node of thoracic esophageal squamous cell carcinoma,and to investigate the strategies of common hepatic artery lymph node dissection.Methods The clinical data of 682 patients with esophageal squamous cell carcinoma who were admitted to the Cancer Hospital of Fudan University from May 2005 to December 2010 were retrospectively analyzed.The locoregional lymph node metastasis of thoracic esophageal squamous cell carcinoma,relationship between metastatic rates of common hepatic artery lymph node and clinicopathological factors and the postoperative complications were analyzed.The enumeration data were analyzed using the chi-square test.Results A total of 18 277 lymph nodes were dissected (27 lymph nodes per patient).The lymph node metastatic rate was 55.87％ (381/682),and the metastatic lymph node ratio was 7.87％ (1438/18 277).Lymph nodes adjacent to the cardia of stomach,laryngeal nerve,lesser curvature of stomach,cervical esophagus,left gastric artery had a higher metastatic rate,while common hepatic artery lymph node had a lower metastatic rate.All the common hepatic artery lymph node metastasis was accompanied with locoregional metastasis.A total of 1480 common hepatic artery lymph nodes were dissected (2 common hepatic artery lymph nodes per patient).Twenty-four patients had common hepatic artery lymph node metastasis,with the metastatic rate of 3.52％ (24/682) and the lymph node ratio of 2.16％ (32/1480).The common hepatic artery lymph node metastatic rates of upper,middle and lower esophageal squamous cell carcinoma were 2.33％ (1/43),3.76％ (16/425) and 3.27％ (7/217),with no significant difference (x2 =0.295,P ＞ 0.05).The common hepatic artery lymph node metastatic rates of patients in T1,T2 and T3 stages were 2.35％ (2/85),5.46％ (10/183) and 2.90％ (12/414),with no significant difference (x2 =2.850,P ＞ 0.05).The common hepatic artery lymph node metastatic rates of patients with high,moderate and poor differentiated esophageal squamous cell carcinoma were 0(0/63),3.50％ (16/457) and 4.94％ (8/162),with no significant difference (x2=3.259,P ＞ 0.05).The common hepatic artery lymph node metastatic rates of patients with diameter of tumor under 3 cm,3-5 cm and above 5 cm were 2.59％ (6/232),3.02％ (11/364) and 8.14％ (7/86),with significant difference (x2 =6.267,P ＜ 0.05).The common hepatic artery lymph node metastatic rates of patients in N0,N1,N2,N3 stages were 0(0/301),2.53％ (5/198),5.65％ (7/124) and 20.34％ (12/56),with significant difference (x2 =62.368,P ＜ 0.05).The common hepatic artery lymph node metastatic rates of patients in stage Ⅰ,Ⅱ,Ⅲ and Ⅳ were 0(0/62),1.78％ (6/337),5.06％ (13/257) and 19.23％ (5/26),with significant difference (x2=25.959,P ＜0.05).Two hundred and twenty-eight patients had postoperative complications with the complication rate of 33.43％ (228/682).The incidence of anastomotic fistula was the highest,which was 11.58％(79/682).Conclusions The metastatic rates of common hepatic artery lymph node in thoracic esophageal squamous cell carcinoma is the lowest.For patients suffered from esophageal cancer in stage I or the tumor diameter under 5 cm,the dissection of common hepatic lymph node can be ommitted in surgery.
