贲门癌食管旁淋巴结转移的特点与手术切口的选择

Characteristics of metastasis of paraesophageal lymph nodes in cardiac cancer and selection of surgical incision

目的探讨贲门癌临床病理特征与食管旁淋巴结转移之间的关系,以便选择合理的手术切口。方法回顾性分析4 4 8例经胸或胸腹联合切口施行手术治疗的贲门癌患者的临床资料。结果下胸段食管旁淋巴结总体转移率为1 0.9 4%(4 9/4 4 8)。男性患者转移率为1 0.2 3%,女性患者转移率为1 3.5 4%,(P>0.0 5)。低、未分化腺癌转移率为1 7.8 3%,高、中分化腺癌转移率为1.58%,(P<0.0 0 1);肿瘤直径≥4 cm转移率为2 5.1 6%,肿瘤直径<4 cm转移率为3.1 1%,(P<0.0 0 1);肿瘤侵犯至胃浆膜层转移率为2 2.0 9%,肿瘤未侵犯至浆膜层转移率为3.9 9%,(P<0.001);Borrmann分型为III,IV型转移率为1 9.9 0%,Borrmann分型为I,II型转移率为3.3 1%,(P<0.0 0 1);肿瘤大小≥4 cm者转移率为2 5.1 6%,<4 cm为3.1 1%;肿瘤侵犯浆膜者转移率为22.09%。未侵犯浆膜者为3.9 9%;肿瘤侵犯食管长度≥2 cm转移率为2 9.4 1%,<2 cm转移率为4.26%,(P<0.0 0 1)。结论肿瘤病理类型、直径、侵犯深度、Borrmann分型以及食管侵犯长度与食管旁淋巴结转移有显著关系。在一定情况下选择经腹手术切口是可行的。

Objective To investigate the relationship between the elinicopathological features of cardiac carcinoma and metastasis of paraesophageal lymph nodes. Methods The clinical data of 448 cases of cardiac eareinumas treated by operation through the left thoracotomv or thoraco-abdominal incision were retrospectively studied. Results The total metastasis rate of inferior paraesophageal lymph nodes （ IPELNs ） in cardiac carcinoma was 10. 94% （ 49/448 ） , and the metastasis of inferior paraesophageal lymph nodes was found in 10. 23% of male patients, in 13. 54% of female patients（ P 〉 0. 05 ）. There was significant difference in lymph node metastatic, rate between puorly-differentiated and undifferentiated adenoearcinoma （17. 83% ） compared with well-differentiated and middle-differentiated adenocareinoma （ 1. 58% ） （ P 〈 0. 001 ） ; and between Borrmann Classification llI and IV （ 19. 90% ） with Borrmann Classification I or II （3. 31% ） （ P 〈0. 001 ）. In cases with diameter of tumor 、≥4cm, serosal invasion, or esophagus invasion ≥2cm, the metastasis rate of IPE1.Ns was 25. 16% , 22. 09% , 29. 41% respectively, meanwhile, the IPELNs metastasis rate in tumor size 〈 4cm, withont serosal invasion , or esophagus invasion 〈 2 em was 3. 11 % , 3.99% , 4. 26% （ P 〈 0. 001 ） . Conclusions The clinical and pathological features of cardiac： carcinoma are closely related to the metastasis of inferior paraesophageal lyntph nodes. In some cases it is feasible to select an abdominal incision.