腹腔动脉干区淋巴结清扫术在食管癌和贲门癌治疗中的价值

Clinical Value of Wide-excision of Celiac Trunk Lymph Node for Thoracic Esophageal Carcinoma and Cardiac Cancer

目的:了解食管癌和贲门癌腹腔动脉干区淋巴结的转移特点及对预后的影响,探讨合理的腹腔区域淋巴结清扫范围。方法:对836例手术切除食管癌和贲门癌患者的临床资料进行分析。结果:腹腔淋巴结转移率60.3%,淋巴结转移度16.8%。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10.4%、10.1%和9.8%。患者术后3年腹腔淋巴结复发转移率为6.1%。患者术后3年生存率为55.7%,其中有腹腔淋巴结转移的患者术后3年生存率为44.6%,低于无腹腔淋巴结转移的患者(72.4%),P<0.05。结论:腹腔淋巴结转移是影响食管癌和贲门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 investigate characteristics of celiac trunk lymph-node metastases of thoracic esophageal carcinoma and cardiac cancer and their influence on the prognosis, and to investigate a reasonable range for regional celiac trunk lymph-node clearance. Methods： Specimens from 836 patients treated with resection of thoracic esophageal carcinoma and cardiac cancer were retrospectively analyzed. Results： The rate of celiac lymph-node metastasis was 60.3% （502/836）. Of the lymph nodes detected, 16.8% were found with metastasis. The extent of metastasis adjacent to the common hepatic artery and celiac trunk and within the hepatoduodenal ligaments was 10.8%, 10.1% and 9.8%, respectively. The overall rate of regional celiac recurrence at 3 years after surgery was 6.1%. The 3-year survival for patients with metastases in the celiac lymph nodes was 44.6%, lower than that in non-metastatic patients （72.4%） （P〈0.05）. Conclusion： Celiac lymph-node metastasis is one of key factors affecting the prognosis of patients treated with resection of esophageal cancer and cardiac cancer. Extensive clearance of the celiac-trunk lymph nodes can reduce the rate of postoperative regional metastasis.