食管癌手术中胃左动脉旁淋巴结切除的临床意义

Clinical Significance of Para Left Gastric Artery Lymph Node Resection in Radical Operation of Esophageal Cancer

目的探讨食管癌胃左动脉旁淋巴结转移的相关因素,评价胃左动脉切除在食管癌手术中的意义。方法186例食管癌患者行食管癌切除食管胃吻合术,手术切除肿瘤时常规连同胃左动脉及其周围所有淋巴结和脂肪组织切除,根据胃左动脉旁淋巴结是否转移将患者分为两组,胃左动脉旁淋巴结转移阳性组和胃左动脉旁淋巴结转移阴性组;采用t检验、卡方检验、秩和检验和log istic回归对组间可能影响胃左动脉旁淋巴结转移的因素进行分析。结果186例患者中胃左动脉旁淋巴结转移阳性33例(17.74%)。单因素分析显示肿瘤TNM分期、食管旁、贲门旁、隆突下淋巴结转移等因素与食管癌胃左动脉旁淋巴结转移相关(P<0.001,P=0.025,0.047,0.038);多因素分析显示仅肿瘤部位与食管、贲门癌胃左动脉旁淋巴结转移相关(P=0.002);胃左动脉旁淋巴结跳跃式转移发生率为78.79%(26/33)。结论食管癌胃左动脉旁淋巴结转移主要与肿瘤部位相关,食管癌术中应常规切除胃左动脉及周围组织。

Objective To investigate the related factors affecting the metastases to left gastric artery lymph nodes in patients of esophageal cancer, and evaluate the clinical significance of resection of left gastric artery. Methods One hundred and eighty-six patients with esophageal cancer undergone esophagectomy and esophagogastrostomy were involved in these case-control study. The left gastric artery, lymph nodes and fat tissue around it were removed in these patients. Patients were divided into 2 groups according to the occurrence of metastases to para left gastric artery lymph nodes. Chi-square test, rank sum test, t-test and the logistic regression were adopted to analyze the correlations between these related factors and the metastases to para left gastric artery lymph nodes. Results Thirty-three patients had para left gastric artery lymph nodes metastases （17. 74%）. Related factors that affect the metastases to para left gastric artery lymph nodes were showed by monovariate analysis as follows： TNM staging of tumor, the metastases to paraesophageal nodes, paracardial nodes and subcarinal nodes （P〈0.001,P=0.025,0.047,0.038）. Multivariate analysis showed that location of tumor was the only independent factor that influences the metastases of para left gastric artery lymph nodes（P= 0. 002）. Skip metastasis was a distinct feature of esophageal cancer, with a frequency of 78.79%（26/33）. Conclusions This study suggests that the major correlative factor of para left gastric artery lymph node metastasis is location of tumor. Resection of left gastric artery as a routine procedure in radical operation of esophageal cancer should be considered.