胸中段食管癌淋巴结二野清扫术和三野清扫术的比较

Comparison of two-field dissection and three-field dissection in esophageal chest lymph node dissection

目的 探讨二野清扫术和三野清扫术在胸中段食管癌淋巴结中的应用.方法 选择解放军第一五九医院肿瘤科2013年1月至2014年1月收治的胸中胸段食管癌患者100例,随机分为二野组和三野组,每组50例.二野组采用二野淋巴结清扫术联合Ivor-Lewis术,三野组采用三野淋巴结清扫术联合Akiyama术,对效果进行比较.结果 二野组总淋巴结清扫数量为950个,范围8 ～ 39个,观察淋巴结转移数目共86个;三野组在总淋巴结清扫数为1500个,范围16 ～ 62个,观察淋巴结转多数目共80个;淋巴结转移在二野组的发生率为48％,三野为70％,差异有统计学意义（P＜0.05）.二野组纵隔加胃周淋巴结转移率为50％,三组为44％;二野组腹腔干淋巴结转移率为4％,三野组为6％,差异均无统计学意义（P＞0.05）.二野组中下纵隔淋巴结转移率为32％,三野组为24％,差异有统计学意义（P＜0.05）.二野组颈部淋巴结转移率无法评估,三野组为42％.组间上纵隔和颈部淋巴结转移率比较差异有统计学意义（P＜0.05）..二野组淋巴结转移3.3个,三野组为2.8个,均以1～10个为范围,差异无统计学意义（P＞0.05）.二野组平均清扫淋巴结17.0个,三野组为32个,差异有统计学意义（P＜0.05）.二野组淋巴结转多度为10％,明显高于三野组（6％）,二野组转移平度为20％,明显高于三野组（10％）,差异有统计学意义（P＜0.05）.结论 行二野淋巴结清扫时,需对左喉返神经旁淋巴结进行较好清扫,三野淋巴结清扫术预后可能更为理想,对颈部和纵隔的转移淋巴结可彻底清除,对于腹腔淋巴结,清扫颈部和纵隔转移淋巴结意义重大,可显著改善胸中段食管癌的预后.

Objective To study the application of two-field dissection and three-field dissection in esophageal dissection.Methods From January 2013 to January 2014,100 patients with thoracic esophageal carcinoma in our hospital were randomly divided into two-field group and three-field group,with 50 cases in each group.The patients in two-field group received two-field lymphadenectomy joint with Ivor-Lewis surgery,and the patients in three-field group received three-field lymphadenectomy combined with Akiyama surgery,the clinical effects were compared.Results Two wild group statistics show the total number of lymph node dissection was 950,ranged 8-39 months,the number of metastatic lymph nodes was observed,a total of 86 ; three wild groups in the total number of lymph node dissection was shown by the statistics of 1500,the range of 16-62 months to observe the lymph nodes turn more than the number of 80 ; statistical incidence of lymph node metastasis in two wild group was 48％,three wild was 70 ％,there was significant difference between the two groups （P ＜ 0.05）.Plus two wild groups of mediastinal lymph node metastasis of gastric rate of 50％,the three groups was 44％ ; two wild celiac lymph node metastasis group was 4％,6％ for the three wild group,there was no significant difference（P ＞ 0.05）.Two wild group under the mediastinal lymph node metastasis was 32 ％,three wild group was 24％,there was significant difference（P ＜0.05）.Two wild group of cervical lymph node metastasis can not be assessed,three wild group was 42％.Between groups and mediastinal lymph node metastasis rate of major differences.Two-field lymph node metastases 3.3,the statistical showing three wild group 2.8,are in the range of 1 to 10,there was no significant difference（P ＞0.05）.Two-field lymph node dissection group was 17.0,after statistics show three wild group 32,there was significant difference （P ＜0.05）.Two wild group of lymph node degrees is 10％,significantly higher than the three wild groups of 6％ in the second transfer roughness wild group was 20％,significantly higher than the 10percent three wild groups were statistically significant （P ＜ 0.05）.Conclusions Line two field lymph node dissection when required to be better left recurrent laryngeal nerve lymph node dissection,threefield lymphadenectomy prognosis may be classified as an ideal,turn on the neck and mediastinum can remove multiple lymph nodes,the abdominal lymph nodes,neck dissection and mediastinal lymph nodes,the prognosis of esophageal chest cancer can be significantly improved.