选择性三野淋巴结清扫治疗胸段食管癌

Selective Three-field Lymphadenectomy for Treating Thoracic Esophageal Carcinoma

目的探讨选择性三野淋巴结清扫的可行性和术后并发症的防治。方法应用彩超加CT对108例胸段食管癌进行常规术前检查,提示有下颈部淋巴结转移者实施三野淋巴结清扫术,共31例。结果31例中有下颈部淋巴结转移27例(87.1%),其中胸上段癌、中段癌、下段癌的转移率分别为83.3%、92.9%和80.0%(P>0.05),但在108例中的转移率为25.0%;喉返神经链淋巴结转移20例,转移率64.5%;术后3年生存率46.2%;手术死亡1例,术后并发症41.9%。结论彩超加CT判断下颈部淋巴结是否有转移是可行的,可将其列为胸段食管癌的常规术前检查;选择性三野淋巴结清扫降低了手术风险。

Objective To study the feasibility of three-field lymphadenectomy （ 3-FL）, and the prevention and cure of postoperative complications. Methods 108 patients with thoracic esophageal carcinoma were examined by color ultrasound and CT before operation,31 patients with lower-cervical lymph node metastasis were operated by three-field lymphadenectomy. Results In the 31 case, the lymphatic metastasis in lower-cervical were 27 case （87.1% ）, the rate of the upper, middle and the lower pectoral esophageal carcinoma was 83.3% ,92.9% and 80.0% （P 〉 0.05 ）, but the rate was 25.0% in all 108 case. The lymphatic metastasis in recurrent laryngeal nerve were 20 cases （ 64.5% ） ; The three-year survival rate after operation was 46.2% ; One case died,the rate of postoperative complications was 41.9%. Conclusion That is feasible to judge the lower-cervical lymph node metastasis by color ultrasound and CT,it should be use as a routine preoperative examination;Selective three-field lymphadenectomy can decrease the operative risk.