颈胸腹三野淋巴结清扫术对胸中上段食管癌患者预后的影响

Influence of three-field lymphadenectomy on prognosis of esophageal cancer in superior and middle segment

目的 探讨颈胸腹三野淋巴结清除术对胸中上段食管癌患者预后的影响.方法 选取本院心胸外科自2013年9月至2015年6月收治的胸中上段食管癌患者96例,根据淋巴结清扫方式的不同将所有患者分为两组,三野组（48例）行三野淋巴结清扫术,二野组（48例）行二野淋巴结清扫术.比较两组患者手术前后血清预后指标、肿瘤学指标、术后并发症发生情况及随访期1年内无病生存率和总生存率的差异.结果 三野组患者术后血清LDH、NO及NOS水平分别为（133.62±12.81） U/L、（66.39±5.73）μmol/L、（1.36±0.13） U/ml,二野组分别为（199.07±13.33） U/L、（44.18±3.56）μmol/L、（2.88±0.17）U/ml,三野组患者术后血清预后指标明显优于二野组,差异具有统计学意义（P＜0.05）;三野组患者术后血清CEA、Cyfira21-1、SCC水平分别为（7.45±0.62） ng/ml、（2.17±0.17） ng/ml、（0.36±0.03） ng/ml,二野组分别为（15.71±1.44） ng/ml、（2.95±0.22） ng/ml、（0.98±0.08）ng/ml,三野组患者术后血清肿瘤学指标明显优于二野组,差异具有统计学意义（P＜0.05）;三野组患者1年随访期内无病生存率和总生存率明显高于二野组,但术后喉返神经损伤发生率则高于二野组,组间差异具有统计学意义（P＜0.05）.结论 颈胸腹三野淋巴结清扫术用于治疗胸中上段食管癌,可有效改善患者的血清预后指标及肿瘤学指标水平,提高远期无病生存率及总生存率,具有一定的临床推广价值.

Objective To investigate the influence of three-field lymphadenectomy on prognosis of esophageal cancer in superior and middle segment.Methods 96 patients with esophageal cancer in superior and middle segment treated at our department form September,2013 to June,2015 were randomly divided into a threefield group and a two-field group,48 for each group.The three-field group were treated with lymphadenectomy and the two-field group with two-field lymphadenectomy.The serum prognostic and oncological indexes before and after operation,complications,disease free survival rate and overall survival rate within 1 years after the operation were compared between these two groups.Results After operation,The serum levels of LDH,NO,and NOS were （133.62±12.81） U/L,（66.39±5.73） μmol/L,and （1.36±0.13） U/ml in the three-field group and were （199.07±13.33） U/L,（44.18±3.56） μmol/L,（2.88±0.17） U/ml in the two-field group,with statistical differences （P〈0.05）.The serum levels of CEA,Cyfra21-1,and SCC were （7.45±±0.62） ng/ml,（2.17±0.17） ng/ml,and （0.36±0.03） ng/mL in the three-field group and were （15.71±1.44） ng/ml,（2.95±-0.22） ng/ml,and （0.98±0.08） ng/ml in the two-field group,with statistical differences （P〈0.05）.The 1-year disease-free survival and 1-year overall survival rate of the three-field group was significantly higher than that of the two-field group （P〈0.05）,but the incidence of recurrent laryngeal nerve injury was higher in the three-field group than in the two-field group （P〈0.05）.Conclusions Three-field lymphadenectomy for esophageal cancer in superior and middle segment can improve the patients＇ levels of serum prognostic and oncological indexes and increase longterm disease-free survival rate and overall survival rate,so it has a certain clinical value.