胸中下段食管癌淋巴结转移强度及临床分析

Lymph node metastasis intensity of thoracic middle-lower segment esophageal squamous cell carcinoma

目的:探讨胸中下段食管癌淋巴结转移规律及合理的淋巴结清扫范围。方法:回顾性分析325例经手术切除胸中下段食管癌患者的临床资料。结果:148例(45.54%)发生淋巴结转移,共清除淋巴结4 063枚,转移淋巴结643枚,淋巴结转移度15.83%。食管癌淋巴结转移具有上下双向性和跳跃性,影响淋巴结转移的主要因素为肿瘤浸润深度和分化程度,肿瘤部位及病变长度则影响不大。结论:浸润深度及分化程度是影响食管癌淋巴结转移强度的主要因素,对胸中段食管癌早期病变患者可行三野淋巴结清扫,对胸下段食管癌行二野淋巴结清扫即可。

Objective To study the incidence of lymph node metastasis of thoracic middle lower segment esophageal squamous cell carcinoma and find reasonable dissecting range of lymph nodes. Methods The clinical data of 325 patients receiving resection of thoracic middle lower segment esophageal carcinoma were retrospectively studied. Results A total of 4 063 lymph nodes were dissected, in which lymph node metastasis was found in 643 lymph nodes （148 patients）. The overall lymph node metastasis rate was 45.54%. The degree of lymph node metastasis was 15.83%. The lymph node metastasis had the features of extending vertically in both directions and leaping over. Lymph node metastasis was influenced by tumor differentiation and the depth of tumor invasion but not the length or the site of tumor. Conclusion Tumor differentiation and the depth of tumor invasion are the main factors influencing lymph node metastasis intensity. The cervical, thoracic and abdominal lymph node dissection should be done for the patients with earlier esophageal carcinoma of the middle thoracic segment. The thoracic and abdominal regional lymph node dissection is appropriate to esophageal carcinoma of the lower thoracic segment.