胸段食管癌颈部及上纵隔淋巴结转移

Cervical and Upper Mediastinal Lymph Node Metastasis in Thoracic Esophageal Carcinoma

目的：探讨胸段食管癌颈部及上纵隔淋巴结转移规律。方法：采用颈、胸、腹三切口施行胸段食管癌手术６１６例，同时施行三区域淋巴结清扫。结果：颈部及上纵隔淋巴结转移率和转移度分别为５７．１％和２１．５％。其中胸中、上段食管癌颈部淋巴结转移率分别为３９．４％、４３．７％，右胸顶淋巴结转移率分别为１５．０％、３７．５％，气管旁淋巴结转移率分别为１３．７％、２５．０％。即使是胸下段食管癌颈部及右胸顶仍有１８．５％、２２．２％的淋巴结转移。结论：胸段食管癌必须重视颈部及上纵隔淋巴结清扫。

Aim:To assess the probability of cervical and upper mediastinal lymph node metastasis in thoracic esophageal carcinoma .Clinical material and method:From 1989 to 1996,616 patients with thoracic esophageal carcinoma underwent esophagectomy through right thoracotomy and three field lymphadenectomy.There were 388 males and 228 females.The tumor located in upper portion of the esophagus in 64 patients,middle portion in 452 and lower part in 108.According to pTNM classification,stage 0 was in 2 patients,stage I in 28,stage IIa in 184,stage IIb in 172,stage III in 144 and stage IV in 86.Results:352 patients had cearival and upper midastinal lymph node metastasis with a metastasis rate of 57.1%.Metastases were found in 21.5%(1792/8344)of total dissected lymph nodes;in which 23.8% (384/1630) from neck and 33.1%(210/606) from upper mediastinum.When cancer is located in the upper and middle portion of esophagus ,lymph node metastasis were 43.7% and 39.4% in the neck,37.5% and 15% in the upper mediastinum.When cancer is T 3 and T 4,lymph node metastasis were 43.6% and 56.6% in the neck,24.6% and 33.3% in the upper mediastinum.Conclusion:The results of this study indicate that carcinoma in the upper and middle portion of the esophagus have higher rate of lymph node metastases in the neck and upper mediastinum.In order to prevent lymph node recurrence and to improve long term survival,extended lymph node dissection of three field,particularly the neck and upper mediastinum,shoud be performed routinely.