胸段食管鳞癌淋巴结转移规律和淋巴结清扫方式探讨

Impact of the pattern of lymph node metastasis on the clinical sphere of lymphadenectomy for thoracic esophageal squamous cell carcinoma

目的研究胸段食管鳞癌淋巴结转移规律,探讨胸段食管癌术中淋巴结清扫方式的依据。方法回顾性分析480例行根治术的胸段食管鳞癌患者,标记各部位清扫淋巴结分别送检,进行临床病理资料分析,研究淋巴结转移规律,为食管癌淋巴结清扫范围提供理论依据。结果胸上、中、下段食管癌颈部淋巴结转移率分别为47.2%、10.5%和2.2%,上纵隔分别为22.6%、23.5%和3.7%,中纵隔分别为7.5%、69.3%和11.0%,下纵隔分别为0.9%、28.6%和33.8%,腹部分别为3.8%、19.7%和33.1%。胸部各段食管癌淋巴结转移部位比较差异有统计学意义(P约0.05)。病变长度愈长、肿瘤分化越低、肿瘤浸润越深食管癌淋巴结转移率也越高(P约0.05)。结论胸上段食管癌淋巴结转移以颈段食管旁、锁骨上、上中纵隔转移多见,胸中段食管癌淋巴结转移具有明显的上下双向转移和跳跃性转移特点,胸下段食管癌淋巴结转移以腹部、中下纵隔转移多见。建议胸上段食管癌行颈、胸、腹三野淋巴结清扫,重点清扫颈段食管旁及锁骨上、下界包括隆突下淋巴结,胸下段食管癌可行胸、腹两野淋巴结清扫,重点清扫隆突下、下胸段食管旁、胃左动脉旁淋巴结,胸中段食管癌淋巴结清扫方式应根据具体情况设定。

Objective To study the pattern of lymph node metastasis of thoracic esophageal squamous cell carcinoma （ESCC） and investigate its impact on the clinical sphere of lymphadenectomy.Methods 480 patients with thoracic esophageal squamous cell carcinoma who had undergone esophagogartrectomy were analyzed.The pattern of lymph node metastasis was studied by analyzing all the clinical and pathologic materials.Based on these data,the clinical sphere for lymphadenectomy was suggested.Results The pattern of lymph node metastasis among different segments of the esophagus were found statistically different （P〈0.05）.For the upper,middle and lower thoracic esophageal section,the rate of metastasis was 47.2%,10.5% and 2.2% for the cervical lymph nodes;22.6%,23.5% and 3.7% for the upper mediastinal lymph nodes;7.5%,69.3% and 11.0% for the middle mediastinal lymph nodes;3.8%,19.7% and 33.1% for the celiac lymph nodes.The rate of lymph node metastasis of the thoracic ESCC increased with the increase of tumor length,the depth of tumor invasion and the decrease of tumor differentiation （P〈0.05）.Conclusions Metastasis to the cervical,supraclavicular and high mediastinal lymph nodes is mainly occurs in patients with the upper thoracic ESCC.Lymph node metastasis in the middle thoracic ESCC has upward,downward and skip spread characteristics.Lymph node metastasis to the abdominal cavity,middle and low mediastinum mainly occurs in patients with the lower thoracic ESCC.We suggest that the upper thoracic ESCC should perform three field lymphadenectomy,especially include the cervical para-esophageal,supraclavicular lymph nodes and subcardinal lymph nodes.For the lower thoracic ESCC should perform two field lymphadenectomy,including the subcarinal lymph nodes and left gastric lymph nodes.The pattern of lymphadenectomy for the middle thoracic ESCC should be designed according to different situations.