食管胸段鳞癌右喉返神经旁淋巴结转移的相关性因素分析及其临床意义

Related factors and clinical significance of right recurrent laryngeal nerve lymph node metastasis in 300 cases of thoracic esophageal carcinoma

目的 探讨食管胸段鳞癌右喉返神经旁淋巴结转移的相关性因素及其右喉返神经旁淋巴结清扫的临床意义.方法 对300例胸段食管鳞癌切除术中行右喉返神经旁淋巴结清扫患者的临床病理资料进行回顾性分析,采用χ2检验进行单因素分析,Logistic回归进行多因素分析.结果 300例食管胸段鳞癌患者中,右喉返神经旁淋巴结转移93例,转移率为31%.右喉返神经旁淋巴结总清扫枚数为1124枚,转移枚数为145,转移度为12.90%.Logistic回归分析结果显示,食管胸段鳞癌的浸润深度、分化程度、淋巴结转移总数、脉管癌栓形成、胃左动脉旁淋巴结、贲门淋巴结转移、隆突下淋巴结转移、瘤体长度均是影响右喉返神经旁淋巴结转移的独立因素.结论 胸段食管鳞癌中右喉返神经旁淋巴结转移率高,应按照淋巴结转移的影响因素进行合理的清扫;右喉返神经旁淋巴结转移可能影响患者的预后,应综合全身情况给予术后辅助的放化疗.

Objective To further study the related factors of right recurrent laryngeal nerve （RRLN） lymph node metastasis from thoracic esophageal carcinoma（TEC） and the clinical significance of dissection. Methods A total of 300 TEC patients received esophagectomy and RRLN lymph node dissec-tion. Univariate data were analyzed by chi-square test, and multivariate data were analyzed by logistic re-gression. Results The RRLN lymph nodal node metastasis of TEC was found in 80 cases （36.4%）. In the 1124 excised RRLN lymph nodes, metastases were found in 145 nodes （12.90%）. Infiltration depth of TEC,grade of differentiation, total numbers of metastatic lymph nodes, vascular invasion, left gastric and cardial lymph node metastasis, subcarinal lymph node metastasis, and tumor length were independent risk factors of RRLN lymph node metastasis in TEC. Conclusion Considering the high risk factors of lymph node metastasis, RRLN lymph nodes in TEC should be dissected reasonably. RRLN lymph node metastasis may have impact on prognosis,so overall conditions should be integrated to give a supplementary chemo- therapy after operation.