CAJ | 학술논문

目的：探讨食管癌纵隔上、下气管旁淋巴结（第2、4组淋巴结）清扫的必要性。方法2010年1月～2013年11月行胸腔镜或胸腔镜联合腹腔镜下食管癌根治术164例，颈部淋巴结选择性清扫，胸部及腹部淋巴结常规清扫。在游离食管后，用电钩及超声刀逐一清扫第1～8组纵隔淋巴结、双侧喉返神经旁淋巴结，将淋巴结与其周边脂肪组织整块切除。分析第2、4组淋巴结转移情况、清扫时间及并发症发生率；各组淋巴结总体转移率；性别、肿瘤位置、浸润深度、分化程度对第2、4组淋巴结转移率的影响。结果第2、4组淋巴结清扫时间6～16 min，并发症发生率1．8％（3／164），转移率5．5％（9／164），与第1组（4．9％）、第7组（10．4％）和左喉返神经旁淋巴结（7．3％）转移率差异无统计学意义（P＞0．05），与第8组（14．0％）和右喉返神经旁淋巴结（12．8％）转移率差异有统计学意义（P＜0．05）。性别、肿瘤位置、浸润深度、分化程度与第2、4组淋巴结是否转移差异均无统计学意义（P＞0．05）。结论常规行第2、4组淋巴结清扫有必要，相应增加的手术创伤可接受。
목적：탐토식관암종격상、하기관방림파결（제2、4조림파결）청소적필요성。방법2010년1월～2013년11월행흉강경혹흉강경연합복강경하식관암근치술164례，경부림파결선택성청소，흉부급복부림파결상규청소。재유리식관후，용전구급초성도축일청소제1～8조종격림파결、쌍측후반신경방림파결，장림파결여기주변지방조직정괴절제。분석제2、4조림파결전이정황、청소시간급병발증발생솔；각조림파결총체전이솔；성별、종류위치、침윤심도、분화정도대제2、4조림파결전이솔적영향。결과제2、4조림파결청소시간6～16 min，병발증발생솔1．8％（3／164），전이솔5．5％（9／164），여제1조（4．9％）、제7조（10．4％）화좌후반신경방림파결（7．3％）전이솔차이무통계학의의（P＞0．05），여제8조（14．0％）화우후반신경방림파결（12．8％）전이솔차이유통계학의의（P＜0．05）。성별、종류위치、침윤심도、분화정도여제2、4조림파결시부전이차이균무통계학의의（P＞0．05）。결론상규행제2、4조림파결청소유필요，상응증가적수술창상가접수。
Objective To investigate the necessity of upper paratracheal lymph nodes ( group 2 lymph nodes ) and lower paratracheal lymph nodes ( group 4 lymph nodes) dissection for esophageal carcinoma. Methods A total of 164 patients with esophageal carcinoma underwent video-assisted thoracoscopic radical esophagectomy between January 2010 and December 2013.The cervical lymph nodes were selectively dissected, while the thoracic and abdominal lymph nodes were routinely dissected.After the esophagus was disconnected, the mediastinal lymph nodes, as well as lymph nodes adjacent to the bilateral recurrent laryngeal nerves, were resected from the group 1 to 8 one by one by using electric hook and ultrasonic scalpel.The lymph nodes and their adjacent tissues were en bloc resected.The operation duration and complication rate of lymph nodes dissection were retrospectively reviewed.An analysis was made on the difference between lymph node metastasis rate of group 2 and 4 lymph nodes, different tumor locations, infiltration depth and degrees of differentiation. Results The operation duration of group 2 and 4 lymph nodes dissection was 6-16 min, while the complication rate was 1.8%(3/164).The metastasis rate of group 2 and 4 lymph nodes was 5.5% (9/164), with statistically significant difference with group 8 (14.0%) and right recurrent laryngeal nerve lymph nodes (12.8%) but no differences with group 1 (4.9%), group 7 (10.4%) and left recurrent laryngeal nerve lymph nodes (7.3%)(P>0.05).Single factor analysis showed that gender, tumor location, infiltration depth and degrees of differentiation had no influence to the metastasis of group 2 and 4 lymph nodes (P>0.05). Conclusion Lymphadenectomy of group 2 and 4 lymph nodes has a positive significance in the treatment of esophageal cancer, with acceptable surgical trauma.