食管癌微创手术下颈胸腹三野和二野淋巴结清扫效果对比

Effects of three-field and two-field lymph node dissection by means of esophagectomy with minimal invasion:a comparative study

目的探讨食管癌微创手术下颈胸腹三野和二野淋巴结清扫效果。方法 60例食管癌患者依据淋巴结清扫方式分为二野组和三野组,比较两组患者的手术相关情况、淋巴结清扫情况、术后并发症及生存率。结果三野组手术时间、术中出血量、淋巴结清扫均数、胃管拔除时间、住院时间均显著高于二野组(P<0.05),2组的转移率、转移度均无显著差异(P>0.05);二野组的术后并发症总发生率为13.33%,三野组为30.00%,差异具有统计学意义(P<0.05)。二野组患者的1年、3年、5年生存率分别为86.67%、46.67%、30.00%,三野组患者分别为96.67%、60.00%、46.67%;差异均有统计学意义(P<0.05)。结论三野淋巴结清扫术能够有效降低淋巴结转移风险,提高食管癌患者生存率,但术后并发症较二野淋巴结清扫术更多,临床上应加强术后护理。

Ohjective To determine the effects of two approaches for removing the lymph nodes, namely, three-field and two field lymph node dissection methods, by means of esophagectomy incurring minimal invasion. Method 60 patients of esophageal cancer were divided into two groups according to the differing approaches they were subjected to for lymph node dissection, namely, two-field group and three-field group. The processes of surgery, outcomes of lymph node dissection, postoperative complications and survival rate of both groups were then documented and compared. Findings The scores that the three-field group achieved in operation time, intraoperative bleeding volume, lymph node dissection number, extubation time, hospitalization time were significantly higher than those of the two-field group. The difference was statistically significant （P 〈 0.05）. No significant difference was found between the two groups in the rate of metastasis and the severity of metastasis （P 〉 0.05）. The postoperative complication occurrence rate of the two-field group was 13.33% while that of the three-field group was 30.0%. The difference was statistically significant （P 〈 0.05）. The survival rates of the three-field group as observed 1 year, 3 years and 5 years after surgery were 96.67%, 60.00% and 46.67% respectively while those of the two-field group were 86.67%, 46.67% and 30.00% respectively. The differences were statistically significant. Conclusion Three-field lymph node dissection can more effectively reduce the risk of lymph node metastasis and improve the rate of survival. However, it brings about higher occurrence rate of postoperative complications compared with 2-field lymph node dissection and hence requires strengthened postoperative nursing.