T2胸中段食管鳞癌淋巴结转移特点和规律

Lymph node metastasis pattern in patients with T2 and middle thoracic esophageal squamous cell carcinoma

目的探讨T2胸中段食管鳞癌淋巴结转移特点和规律。方法分析246例接受颈、胸、腹三野淋巴结清扫的1r2胸中段食管鳞癌病人的临床病理指标与淋巴结转移的关系。结果每例病人清扫淋巴结15～59枚，平均25枚。其中129例存在区域淋巴结转移。颈、胸和腹三区淋巴结转移率分别为28．9％、28．5％和22．0％，差异无统计学意义。Logistic回归模型显示肿瘤长度、肿瘤细胞分化程度及有无淋巴管血管浸润是影响淋巴结转移的有意义因素。结论T2胸中段食管鳞癌淋巴结转移与肿瘤长度、肿瘤细胞分化程度及有无淋巴管血管浸润明显相关；T2胸中段食管鳞癌有上、下双向转移和跳跃性转移的特点，应行三野淋巴结清扫，对胸中段超出T2的食管鳞癌也应行以上手术。

Objective To investigate the pattern of lymph node metastasis in patients with T2 and middle thoracic esophageal squamous cell carcinoma（ESCC）. Methods Retrospective review the clinical data of 246 cases with 3＂2 and middle thoracic esophageal squamous cell carcinoma who were treated by three-field lymphadenectomy. Analyze the relationship between clinical pathological factors and lymph node metastasis. Results Lymph node metastases were found in 129 of the 246 patients（52.4% ）. The average number of resected lymph nodes was 25 per patient （rangel5 -59）. The rates of lymph node metastasis were 28.9% in the neck, 28.5% in thoracic mediastinum and 22.0% in abdominal cavity for patients with T2 and middle thoracic ESCC. No significant difference in lymph node metastasis＇ rate was observed among the neck, thoracic mediastinum and abdominal cavity. Logistic-regression showed the length of tumor, tumor cell differentiation and anglolymphatlc invasion were factors influencing lymph node metastasis. Conclusion Lymph node metastasis in T2 and middle thoracic ESCC has the characteristics of upward, downward and skip spreading. Patients with T2 and iniddle thoracic ESCC should be treated with radical surgery with three-field lymphadenectomy.