胸中上段食管癌三野淋巴结清扫及二野淋巴结清扫疗效比较

Comparison of three-field lymphadenectomy with two-field lymphadenectomy for upper thoracic esophageal carcinoma

目的比较胸中上段食管癌行三野淋巴结清扫术及二野淋巴结清扫术的临床疗效。方法回顾性分析襄阳市中心医院胸心外科2012年1月至2013年12月收治的98例胸中上段食管癌患者的临床资料和随访结果,所有患者均行食管癌根治术治疗。其中50例行三野淋巴结清扫术,48例行二野淋巴结清扫术,比较两组患者治疗后的围术期并发症、清扫淋巴结数、淋巴结转移数、随访淋巴结复发率以及3年生存率等情况。结果术后心肺并发症发生率、术中出血量、吻合口瘘发生率等指标三野清扫组与二野清扫组比较,差异均无统计学意义(P>0.05);三野清扫组与二野清扫组的平均清扫淋巴结数(28.04枚vs 18.23枚)和平均阳性淋巴结数(5.52枚vs 2.25枚)比较,三野清扫组均多于二野清扫组,差异均有统计学意义(P<0.05);95例完成随访,平均随访时间为26.6个月,其中三野清扫组48例,二野清扫组47例;随访期间三野清扫组患者的淋巴结复发率为37.5%(18/48),明显低于二野清扫组的53.2%(25/47),差异有统计学意义(P<0.05);三野清扫组患者的3年生存率为56.3%(27/48),明显高于二野清扫组的38.3%(18/47),差异有统计学意义(P<0.05)。结论胸中上段食管癌行三野淋巴结清扫食管癌根治术安全可行,该术式下颈部及上纵隔淋巴结清扫更彻底,可降低局部复发率,提高患者术后生存率,具有一定的临床意义。

Objective To analyze the different effects of three-field lymphadenectomy and two-field lymphade-nectomy in the treatment of upper thoracic esophageal carcinoma. Methods The clinical data and follow-up results of 98 upper thoracic esophageal cancer patients who admitted to Department of Cardiothoracic Surgery of Xiangyang Cen-tral Hospital and accepted surgical treatment from January 2012 to December 2013, including 50 cases of three-field lymphadenectomy （three-field group） and 48 cases of two-field lymphadenectomy （two-field group）, were retrospective-ly analyzed. The surgery-related and follw-up indicators were compared between the two groups. Results There were no significant differences in the incidence of postoperative cardiopulmonary complications, intraoperative blood loss, in-cidence of anastomotic fistula between three-field group and two-field group （P〉0.05）. The mean number of lymph nodes dissected and number of positive lymph nodes in the three-field group were 28.04 and 5.52, respectively, which were significantly higher than 18.23 and 2.25 in the two-field group （P〈0.05）. The follow-up was successfully per-formed in 95 cases with the average time of 26.6 months, among of which, 48 cases belonged to the three-field group, and 47 cases enrolled into the two-field group. The rate of lymph node metastasis was 37.5%（18/48） in the three-field group versus 53.2% （25/47） in the two-field group （P〈0.05）, and the 3-year survival rate was 56.3% （27/48） in the three-field group versus 38.3%（18/47） in the two-field group （P〈0.05）. Conclusion The three-field lymphadenectomy in the upper thoracic esophageal carcinoma is safe and feasible, and the lymph node dissection is more thorough. It can reduce the local recurrence rate and improve the postoperative survival rate of patients, which has a certain clinical significance.