T1期食管癌淋巴结转移临床病理特征及手术方式研究进展

Progress of clinical pathological features and surgical approaches of lymph node metastasis for T1 esophageal cancer

T1期食管癌淋巴结转移率较低,预后较好,其五年生存率可达90%以上.随着目前检查手段及患者就诊意识的提高,T1期(早期)食管癌检出率越来越高,有关T1期食管癌的研究也逐渐增多且越来越深入.由于近年来手术方式的规范化,三野淋巴结清扫较过去明显增加,T1期食管癌淋巴结转移的发现率也随之增多.而肿瘤浸润深度、分化程度、肿瘤位置与病理形态等是T1期食管癌淋巴结转移的重要危险因素.对于局限于黏膜层的食管癌首选内镜下切除术,肿瘤突破至黏膜下层,仍选用根治性手术切除.腔镜手术也逐渐应用于T1期食管癌.本文就T1期食管癌淋巴结转移临床病理特征及手术方式做一综述,为评估T1期食管癌淋巴结转移风险,制定最佳的手术方案提供理论基础.

The lymph node metastasis rate of stage T1 esophageal cancer is low and the prognosis is good.Its five-year survival rate can reach more than 90%.With the improvement of current examination methods and patients'medical consciousness,the detection rate of esophageal cancer in stage T1(early stage)is getting higher and higher,and the studies on stage T1 esophageal cancer are gradually increasing and deepening.Due to the standardization of surgical methods in recent years,three field lymph node dissection has increased significantly compared with the past,and the detection rate of lymph node metastasis in stage T1 esophageal cancer has also increased.The depth of tumor infiltration,differentiation degree,tumor location and pathological morphology are important risk factors for lymph node metastasis of stage T1 esophageal carcinoma.Endoscopic resection is preferred for mucosal layer tumors.Radical resection is still adopted for tumors that break through to the submucosal layer.Thoracoscopic and laparoscopic esophagectomy are also increasingly used in stage T1 esophageal cancer.This article reviews the clinical pathological feature of lymph node metastasis for T1 esophageal carcinoma and surgical approaches.In order to assess the risk of lymph node metastasis for T1 esophageal cancer,and provide theoretical basis for the best surgical options.