胸段食管癌三野根治术217例临床分析

Clinical analysis of three-field lymphadenectomy for thoracic esophageal carcinoma

目的总结食管次全切除并三野淋巴结清扫根治术治疗胸段食管癌的临床经验。方法收集2002年1月至2008年2月于我科行食管次全切除,颈、纵隔、腹腔三野淋巴结清扫治疗的217例胸段食管癌患者,其中男170例,女47例,年龄36-78岁,平均(56.7±7.2)岁;上段食管癌55例,中段食管癌111例,下段食管癌51例;病变长度<3.0cm者52例,3.1-5.0cm者98例,5.0cm以上者67例;术后病理报告:鳞状细胞癌205例,鳞腺癌7例,腺癌5例。结果202例(93.09%)患者获根治性切除,无围手术期死亡;术后并发症发生率为28.57%(62/217),但经及时处理均顺利恢复。本组病例中颈部、上纵隔淋巴结转移率分别为16.13%、22.58%。食管切缘均无肿瘤残留。随访6个月至5年,死亡23例,其中26例已经存活5年。吻合口肿瘤复发3例。结论采用三野根治术治疗胸段食管癌是必要的、可行的,可提高肿瘤根治率,减少肿瘤复发,有利于转移淋巴结的清扫,特别适合食管中上段癌,颈部、上纵隔淋巴结有转移的病例。通过防治,不增加手术并发症和死亡率。

Objective To summarize the clinical experience of subtotal esophagectomy with three - field lymphadeneetomy for the treatment of thoracic esophageal carcinoma. Methods The data of 217 patients, averagely aged 56.7 years（ range of 36 - 78）, with thoracic esophageal carcinoma of our department from Jan. 2002 to Feb. 2008 were analyzed, in which were 172 men and 71 women. The number of the tumor located at upper, middie and lower segment was 55, 111 and 51 cases respectively. The number of the length of primary tumors less than 3.0, 3.0 - 5.0 and more than 5.0 centimeter was 52, 96 and 67cases respectively. 205, 7 and 5 patients were pathologically diagnosized with squamous cell carcimoma, adeno - squamous and adenocareimoma after surgery respectively. Results 202 （ 93.09% ） cases underwent radical resection with no perioperative mortality, 62 （ 28. 57% ）cases developed postoperative complications. Regional lymph node metastasis occurred in 23 （57. 5% ） cases. The transfer rate of lymph nodes in cervix, upper - mediastinum, mid - and inferior mediastinum and upper abdominal lymph nodes were 16.13%, 22.58%, 24.42% and 14.75%, respectively. There is no carcinoma residual in the edge of the esophagus. All patients were followed up for 6 months to 5 years, with 23 cases died and 3 cases reeurreneed. Conclusion It is feasible to treat esophageal carcinoma by subtotal esophagectomy with three - field lymphadenectomy. This procedure can reduce the relapse and completely clear the positive lymph nodes, hence it is suitable to the patients with positive lymph nodes in cerix and uppermediastinum.