食管癌切除胸腹二区淋巴结清扫手术疗效的研究

Analysis of surgical therapeutic effect of esophagectomy with 2-Field (thoracic and abdominal) lymph node dissection for esophageal carcinoma

目的:分析总结食管癌切除胸腹二区淋巴结清扫的手术疗效。方法:回顾分析1986年2月～2007年12月我院对中下段食管癌和上段食管癌分别采用Ivor-Lewis术式,即上腹正中、右胸后外侧二切口切除及Akiyama术式,即右胸后外侧、上腹正中、左颈部三切口切除,并作胸腹二区淋巴结清扫治疗胸段食管癌1690例的临床资料,总结胸腹二区淋巴结转移的发生率并随访1、3、5年的生存率。结果:全组手术切除率为97.86%(1690/1727)。全组有淋巴结转移782例,占46.27%,其中胸部淋巴结转移占38.93%(658/1690),腹部淋巴结转移占25.92%(438/1690),胸部淋巴结转移发生于最上纵隔位于气管食管沟及喉返神经旁占20.47%(346/1690),术后共有178例发生230例次各种并发症,总的并发症的发生率为13.6%(230/1690),其中肺部并发症为第一位,占34.3%,心律失常占17.4%,喉返神经损伤发生率为8.7%,吻合口瘘发生率为1.7%。术后1、3、5年的生存率分别为88.2%(1161/1316)、63.5%(634/998)和51.8%(331/639)。无淋巴结转移的5年生存率为65.2%(219/336),有淋巴结转移的5年生存率为32.3%(102/316)。结论:Ivor-Lewis术式和Akiyama术式胸腹腔有良好的显露,淋巴结清扫彻底、方便,尤其对右侧最上纵隔沿喉返神经旁淋巴结清扫便利。特别对有淋巴结转移的食管癌患者行胸、腹二区淋巴结清扫十分必要,能明显提高术后5年生存率。

Objective：To summarize the surgical effect of esophagectomy with 2-field （thoracic and abdominal） dissection of lymph nodes for patients with esophageal carcinoma. Methods：1690 patients underwent esophagectomy with 2-field dissection of lymph nodes from Feb.1986 to Dec.2007.Patients with the middle lower segment thoracic esophageal carcinoma underwent Ivor-Lewis esophagectomy,and patients with the upper segment thoracic esophageal carcinoma underwent Akiyama esophagectomy.2-field lymph node metastases information and the 1,3,5 years survival rates were analyzed retrospectively. Results：The rate of resection was 97.86%（1 690/1 727）.Lymph node metastases were found in 782 patients. The lymph node metastases rate was 46.27%.Thoracic lymph node metastases rate was 38.93%（658/1 690）,among which in the topmost mediastinum,tracheoesophageal groove around the recurrent laryngeal nerve was 20.47% （346/1 690）.Abdominal lymph node metastases rate was 25.92% （438/1 690）.There were 230 various postoperative complications occurred in 178 patients.Postoperative complications rate was 13.6%（230/1 690）.Pulmonary complications rate held pride of , were 34.3%.Arrhythmia rate was 17.4%.The recurrent laryngeal nerve injury rate was 8.7%.The anastomotic leakage rate was 1.7%.The survival rate from 1,3 to 5 years were 88.2%（1 161/1 316）,63.5%（634/998）,51.8%（331/639）.The 5-year survival rate with no lymph node metastases was 65.2% （219/336）.The 5-year survival rate with lymph node metastases was 32.3% （102/316）.Conclusion：Study display that Ivor-Lewis and Akiyama esophagectomy expose the operation fields clearly and make radical lymphadenectomy thoroughly,especially the lymph nodes in the back upper mediastinum around the recurrent laryngeal nerve, in the right pleural apical para-trachea triangle. It is essential that patients with esophageal carcinoma with lymph node metastases underwent esophagectomy with 2-field dissection of lymph nodes. This can elevate the postoperative 5-year survival rate remarkably.