CAJ | 학술논문

目的探讨胸段食管癌淋巴结转移的规律和特点,为食管癌淋巴结清扫范围和手术方式提供参考.方法回顾性分析2010年1月至2014年5月间收治的行胸腹腔镜联合食管癌根治术的313例胸段食管鳞癌患者临床资料,记录各组患者的淋巴结清扫及转移情况,并分析淋巴结转移的影响因素.结果 313例患者中,有122例患者发生淋巴结转移,转移率为39.0％(122/313);122例患者共清扫4 461枚淋巴结,(14.3±6.2)枚/例,其中转移淋巴结294枚,淋巴结转移度为6.6％.在各组淋巴结中,喉返神经旁淋巴结的转移率为25.2％,贲门胃左动脉旁淋巴结的转移率为18.2％.单因素分析显示,肿瘤分化程度和T分期与食管鳞癌患者的淋巴结转移有关(均P＜0.001),其中肿瘤位置和分化程度与喉返神经旁淋巴结转移有关(均P＜0.05),肿瘤位置、分化程度和T分期与贲门胃左动脉旁淋巴结转移有关(均P＜0.05).Logistic回归分析显示,肿瘤分化程度和肿瘤位置是影响喉返神经旁淋巴结转移的独立因素(均P＜0.05),肿瘤位置、分化程度和T分期是影响贲门胃左动脉旁淋巴结转移的独立因素(均P＜0.05).结论胸段食管癌易发生喉返神经旁及贲门胃左动脉旁淋巴结转移;对于肿瘤分化程度低、浸润程度深的胸段食管癌患者,应进行广泛的淋巴结清扫.
목적 탐토흉단식관암림파결전이적규률화특점,위식관암림파결청소범위화수술방식제공삼고.방법 회고성분석2010년1월지2014년5월간수치적행흉복강경연합식관암근치술적313례흉단식관린암환자림상자료,기록각조환자적림파결청소급전이정황,병분석림파결전이적영향인소.결과 313례환자중,유122례환자발생림파결전이,전이솔위39.0％(122/313);122례환자공청소4 461매림파결,(14.3±6.2)매/례,기중전이림파결294매,림파결전이도위6.6％.재각조림파결중,후반신경방림파결적전이솔위25.2％,분문위좌동맥방림파결적전이솔위18.2％.단인소분석현시,종류분화정도화T분기여식관린암환자적림파결전이유관(균P＜0.001),기중종류위치화분화정도여후반신경방림파결전이유관(균P＜0.05),종류위치、분화정도화T분기여분문위좌동맥방림파결전이유관(균P＜0.05).Logistic회귀분석현시,종류분화정도화종류위치시영향후반신경방림파결전이적독립인소(균P＜0.05),종류위치、분화정도화T분기시영향분문위좌동맥방림파결전이적독립인소(균P＜0.05).결론 흉단식관암역발생후반신경방급분문위좌동맥방림파결전이;대우종류분화정도저、침윤정도심적흉단식관암환자,응진행엄범적림파결청소.
Objective We analyzed the lymph node (MLNs) metastasis of thoracic esophageal squamous cell carcinoma (ESCC) to explore the patterns of lymphatic spread and the rational surgical procedure and extent of lymph node dissection for ESCC.Methods We retrospectively evaluated 313 consecutive patients treated in our hospital between January 2010 and May 2014 who underwent minimally invasive esophagectomy (MIE) for ESCC.The information of lymph node status was obtained and the features of lymph node metastasis were analyzed.Results Of the 313 cases, 122 (39.0％) were found to have lymph node metastasis.In the 4461 dissected lymph nodes, metastasis was identified in 294 (6.6％) lymph nodes.The recurrent laryngeal nerve lymph nodes were the most frequent metastatic nodes with a metastasis rate of 25.2％, followed by the paracardiac and left gastric artery lymph nodes (18.2％).Chisquare test showed that the lymph node metastasis is associated with tumor invasion and tumor differentiation (P＜0.001 for both).Metastases were more frequently found in the recurrent laryngeal nerve lymph nodes in patients with tumors in the upper third esophagus and with histologically poor differentiation (P＜0.05 for both).The metastasis rate of para-cardiac and left gastric artery lymph nodes was associated with tumor in the lower third of esophagus, T stage and differentiation (all P＜0.05).Logistic regression analysis showed that tumor differentiation and location are independent factors affecting the metastasis of recurrent laryngeal nerve lymph nodes (P＜0.05 for all).T stage, tumor differentiation and location were independent factors associated with metastasis of para-cardiac and left gastric artery lymph nodes (P＜0.05 for all).Conclusions (1) Metastases of thoracic esophageal carcinoma are often found in the recurrent laryngeal nerve lymph nodes, para-cardiac and left gastric artery lymph nodes.(2) Extensive lymph node dissection should be performed for ESCC with poor differentiation and deep tumor invasion.