胸段食管癌淋巴结转移规律的临床研究

To approach the regularity of lymph node metastasis in thoracic esophageal acrcinoma

目的 分析胸段食管癌淋巴结转移规律 ,探讨肿瘤外科淋巴结清扫范围。方法 回顾性分析 2 17例经“三野”淋巴结清除根治术的食管癌患者的临床资料。结果 全组淋巴结转移病例占 6 2 6 % ,转移率11 38% ,淋巴结“跳跃性转移”率为 5 5 %。胸上、中、下段食管癌颈部、胸部纵隔和腹腔淋巴结转移率分别达到 31 7%、2 1 9%、9 75 %、2 1 2 %、30 5 %、12 7%和 12 1%、15 6 %、34 5 %。影响淋巴结转移的因素为肿瘤浸润深度 ,分化程度及有无淋巴管浸润。与肿瘤长度关系不大。结论 胸段食管癌表现上下“双向性”转移和跳跃性转移的特点 ,应常规行“三野”淋巴结清扫术 ,以提高患者 5年生存率。

Objective To approach the regularity of lymph node metastases in thoracic esophageal carcinoma for more reasonable approach of lymph nodes dissection.Methods A retrospective study was perfomed on the clinical data of 217 patients who had underwent radical operation through three-field lymphadenectomy.Results Lymph nodes matastases were defected in 136 of the 217 treated patients(62.6%) and leaping metastases of lymph nodes in 12 patients(5.5%).In 3989 lymph nodes desected,metastases existed in 454(11.38%).The rate of lymph node metastasis present in neck,thoracic mediastinum and abdominal cavity in upper-thoracic esophageal carcinoma was 31.7%,21.2% and 12.1%,in middle-thoracic carcinoma 21.9%,30.5% and 15.6%,in lower-thoracic carcinoma 9.75%,12.7% and 34.5%,respectively.Degree of tumor defferentiation,the depth of tumor invasion and lymphatic vessels invasion were factors infulencing lymph nodes metastases,but the length of the tumor was not.Conclusion Because of the upward,downwar and leaping spreading of esophageal carcinoma cells to the lymph nodes,the patients with thoracic esophagus carcinoma should be given radical operation through three-field lymphadenectomy to promote the 5-years survival rate.