胸段食管癌喉返神经旁淋巴结转移特点及临床意义

Clinical significance and characteristics of recurrent laryngeal nerve lymph node metastasis of thoracic esophageal cancer

目的探讨胸段食管癌喉返神经旁淋巴结转移特点及临床发生率，为术后准确分期、制定后续治疗方案和判断预后提供依据。方法回顾性分析2007年3月至2010年2月，124例行胸段食管癌切除合并喉返神经旁淋巴结清扫术病人的临床和病理资料。结果124例中34例出现了喉返神经旁淋巴结转移，34例共清扫了297枚淋巴结，47枚淋巴结有转移，其转移率为27．41％（34／124例），转移度为15．82％（47／297枚）。34例有转移者中，高分化食管癌4例，中分化食管癌13例，低分化食管癌17例；低分化食管癌比高、中分化食管癌更易发生喉返神经旁淋巴结转移。上段食管癌9例、中段20例、下段5例，上段食管癌喉返神经旁淋巴结转移率为30％，中段为29％，下段为20％，上、中段食管癌喉返神经旁淋巴结转移率明显高于下段食管癌；T26例，T327例，T2的转移率为23．08％（6／26例），T3的转移率为28．72％（27／94例），两组转移率基本相似，P〉0．05。11例术后出现声嘶，发生率为8．87％（11／124例），7例3个月后恢复。结论胸段食管癌病例有近1／3发生喉返神经旁淋巴结转移，尤其是胸上段、低分化、浸润深（T2以上）的食管癌更易发生。

Objective To investigate the clinical significance and characteristics of recurrent laryngeal nerve lymph node metastasis of thoracic esophageal cancer. Methods One hundred and twenty-four patients who had undergone thoracic esophageal resection with recurrent laryngeal nerve lymph node dissection in our hospital from March 2007 to February 2010. All clinical data were retrospectively analysed. Results Recurrent laryngeal nerve lymph node metastasis was found in 34 of 124 cases, with the metastatic rate of 27.41% （34/124）. The left recurrent laryngeal nerve lymph node metastasis was 16.13% and the right was 8.06%. The recurrent laryngeal nerve lymph node metastasis was found in 9 patients with the upper segment esophageal cancer, 20 with middle third esophageal cancer and 5 with lower segment esophageal cancer, 6 patients with T2 disease had recurrent laryngeal nerve lymph node metastasis, while 27 with , T3 disease. Also there were 4, 13, 17 cases with metastasis in well-differentiated, moderately differentiated, poorly differentiated respectively. Poorly differentiated esophageal carcinoma was more susceptible to recurrent laryngeal lymph node metastasis than well-differentiated and moderately differentiated esophageal carcinoma. Recurrent laryngeal nerve injury was found in 11 cases, 7 cases of them recovered. Conclusion Nearly 1/3 of patients with esophageal carcinoma have recurrent laryngeal nerve lymph node metastasis, especially for tumor located in the upper third esophagus, poor differentiation or deep invasion （ T2 or more） of esophageal carcinoma were more susceptible to recurrent laryngeal nerve lymph node metastasis.