胸段食管癌腹腔动脉干区淋巴结转移特点及清扫的临床意义

Characteristics of Regional Celiac Trunk Lymph Node Metastases from Thoracic Esophageal Carcinoma and the Clinical Significance of Extensive Dissection

目的:了解胸段食管癌腹腔动脉干区淋巴结的转移特点及对预后的影响,探讨合理的腹腔动脉干区淋巴结清扫范围。方法:对241例手术切除胸段食管癌患者的临床资料进行回顾性分析。结果:腹腔淋巴结转移率32.4%,转移度9.8%。肝总动脉旁、腹腔动脉旁、肝十二指肠韧带内淋巴结转移度分别为6.6%、6.9%和6.3%。影响腹腔淋巴结转移的因素为肿瘤部位、侵润深度及组织分化程度,肿瘤长度则影响不大。患者术后3年腹腔局部复发率为5.4%。有腹腔淋巴结转移患者的术后3年生存率为42.3%,低于无淋巴结转移患者的70.6%(P<0.01)。结论:腹腔淋巴结转移是影响食管癌切除患者预后的一个主要因素,对腹腔动脉干区淋巴结的广泛清扫可以降低术后的局部复发率。

Objective： To study the characteristics of peripheral celiac trunk lymph node metastases of thoracic esophageal carcinoma and their influence on patient prognosis and to find a reasonable dissecting range for regional celiac trunk lymph nodes. Method： The clinical materials of 241 patients who underwent resection of thoracic esophageal carcinoma were analyzed retrospeetively. Results： Abdominal lymph node metastases were found in 78 of the 241 treated patients （32.4%）. in 3181 abdominal lymph nodes dissected, metastasis existed in 312 （9.8%）. The metastatic rate to lymph nodes near the common hepatic artery, celiac trunk and hepatoduodenal ligament was 6.6%, 6.9%, and 6.3%, respectively. Tumor site, tumor differentiation and the depth of tumor invasion were factors influencing abdominal lymph node metastases, but the length of tumor was not a factor. The postoperative abdominal local recurrence rate was 5.4%. The 3-year survival rate of the patients with lymph node metastasis was 42.3%, much lower than that of patients with no lymph node metastasis （51.9%）. Conclusion： Abdominal lymph node metastasis was one of the key factors affecting prognosis of the patients. Extensive dissection of the regional celiac trunk lymph nodes could decrease the postoperative local recurrence rate.