喉返神经旁淋巴结清扫对胸段食管癌TNM分期的影响

Resecting the lymph node of recurrent laryngeal nerve effect on the TNM stage in thoracic segment esophageal carcinoma

目的通过喉返神经旁淋巴结清扫对新版食管癌TNM分期的影响,探讨该区淋巴结清扫价值。方法筛选浙江省肿瘤医院胸外科行食管癌根治术加术中喉返旁淋巴结清扫,且经病理组织学确诊为胸段食管鳞癌325例患者。采用自身对照方法,按照第7版TNM分期,逐一将325例患者分期,记作A组。假设未行喉返旁淋巴结清扫,剔除喉返旁淋巴结清扫的因素后重新分期,记作B组。应用SPSS 17.0统计软件,比较A组与B组TNM分期变化及分析其在不同胸段食管癌中的差异。结果剔除喉返旁淋巴结清扫因素,325例食管癌中有45例的N分期发生改变,使42例的TNM分期发生改变,变化率12.92%,主要分布在Ⅲ期患者。中、上段及多灶病变的食管癌的TNM分期变化明显,χ2=13.50,P<0.05,具有统计学意义。结论喉返神经旁淋巴结清扫,通过增加淋巴结的检出率,提高了食管癌新版TNM分期的准确性。胸中、上段及多灶的食管癌更需进行喉返神经旁淋巴结清扫。

OBJECTIVE Through resecting the lymph node of recurrent laryngeal nerve effect on the TNM stage to explore the value of this region in thoracic segment esophageal carcinoma .METHODS Screening 325 patients who did radical resection surgery with re-secting the laryngeal recurrent lymph nodes in thoracic surgery of Zhejiang Cancer Hospital .We staged 325 patients one by one according to the seventh edition of TNM stage ,which as group A .Assuming no laryngeal recurrent lymph nodes resected ,we staged again after eliminating the factor of laryngeal recurrent lymph node resecting ,which as group B .SPSS 17.0 statistical software was used to compare group A and group B .We also analyzed the differences of TNM stage in different thoracic segment esophageal cancer .RESULTS After eliminating laryn-geal recurrent lymph node resecting factor ,N staging changed in 45 patients among 325 patients ,which cause 42 cases of TNM staging changed .The rate of change was 12.92% ,mainly distributed in stage Ⅲ patients .The TNM staging changed almost in the superior and mid-dle segment or multifocal lesions .The chi -square test was showed ：χ2 =13.50 ,P=0.001＆lt;0.05 ,which have statistical significance . CONCLUSIONS Resecting laryngeal recurrent nerve lymph node can improve the accuracy of the new edition of TNM staging .The patients who with the tumor in the superior and middle segment or multifocal lesions need pay more attention to the resecting of laryngeal recurrent nerve lymph node .