胸段食管鳞癌淋巴结转移规律探究

Characteristics of lymph node metastasis in thoracic esophageal carcinoma

目的探讨胸段食管鳞癌淋巴结转移规律及其影响因素,以指导淋巴结清扫方式。方法回顾分析漳州市医院2010年4月至2012年7月手术治疗的328例胸段食管鳞癌的临床病理资料,探讨淋巴结转移规律及其影响因素。结果全组328例共清扫淋巴结9 937枚,平均30.3枚/例。共437枚、153例有淋巴结转移,转移率46.65%;其中喉返神经旁淋巴结转移18.30%,10.46%喉返神经旁淋巴结为唯一转移部位。胸段食管癌淋巴结转移与肿瘤部位、长度、分化程度及浸润深度明显相关。胸上段食管癌淋巴结转移方向主要向上纵隔及下颈部;胸中段食管癌颈、胸、腹均可发生淋巴结转移;胸下段食管癌主要向腹腔、中下纵隔转移。结论食管上段鳞癌,颈部淋巴结转移率高,应行三野淋巴结清扫;下段食管癌清扫重点在腹腔、中下纵隔;中段鳞癌应提倡进行个体化清扫和适度清扫;分化程度差,浸润程度深的病例应适当扩大清扫范围。胸段食管癌喉返神经旁淋巴结转移率高,均应行喉返神经旁淋巴结清扫。

Objective To study the pattern of lymph node metastasis in thoracic esophageal carcinoma and to analyze the factors influencing lymph node metastasis and the metastasis direction for more reasonable ap- proach of lymph nodes dissection. Methods 328 patients with thoracic esophageal squamous cell carcinoma （ESCC） who had undergone radical surgery from April 2010 to July 2012 were analyzed. The pattern of lymph node metastasis was studied by analyzing all the clinical and pathologic materials. Results We re-examined 9 937 lymph nodes in the group of 328 case on average of 30.3 piece per case. Among the patients, lymph node metastasis occurred in 153 cases, with the rate of 46.65%. Recurrent laryngeal nerve of lymph node metastasis is occupied 18.30%, 10.46% by recurrent laryngeal nerve is the only transfer part lymph node. The rate of lymph node metastasis of the thoracic ESCC increased with the increase of tumor length, the depth of tumor inva- sion and the decrease of tumor differentiation. Metastasis to the cervical and high mediastinal lymph nodes main- ly occurred in patients with the upper thoracic ESCC. Lymph node metastasis in the middle thoracic ESCC had upward, downward and skip spread characteristics. Lymph node metastasis to the abdominal cavity, middle and low mediastinal mainly occurred in patients with the lower thoracic ESCC. Conclusions We suggest that the upper thoracic ESCC should perform three field lymphadenectomy with the high rate of lymph node metastasis. For the lower thoracic ESCC should perform two field lymphadenectomy. The pattern of lymphadenectomy for the middle thoracic ESCC should be designed according to different situations. With the high rate of lymph node me- tastasis in the recurrent laryngeal nerve, lymphadenectomy is necessary.