微创胸中段食管癌根治术中喉返神经旁淋巴结清扫的临床决策

Clinical decision of paralaryngeallymph node dissection in thoracoscopic Laparoscopic radical resection of middle thoracic esophageal cancer

目的通过分析食管中段鳞癌术后淋巴结转移规律,探讨术中喉返神经旁淋巴结清扫的临床决策。方法选取2014-01-2016-01间郑州大学第一附属医院行微创食管癌根治术的360例食管中段鳞癌患者,记录不同肿瘤浸润深度下各组淋巴结转移率。通过效能指数(各组淋巴结阳性率×术后3 a生存率)评价各组淋巴结清扫的价值,指导术中淋巴结清扫范围。结果肿瘤浸润深度T1~T3期患者淋巴结阳性率分别为1.55%、36.5%、23.8%。双侧喉返神经淋巴结转移率明显高于其他组且右侧高于左侧,差异有统计学意义(P<0.05)。结论双侧喉返神经旁淋巴结在食管中段鳞癌中转移率最高,其中右喉返神经旁淋巴结清扫能明显改善预后,而左喉返神经旁淋巴结清扫仅在T2、T3期更为必要。

Objective Through the analysis of lymph node metastasis after operation of esophageal squamous cell carcinoma,the clinical decision of lymph node dissection beside recurrent laryngeal nerve during operation was discussed.Methods Screening 360 Cases of Minimally Invasive Radical Resection of Esophageal Cancer in the First Affiliated Hospital of Zhengzhou University from 2014 to 2016,the lymph node metastasis rate of each group under different tumor infiltration depth was recorded.The efficacy index(positive rate of lymph nodes in each group×3 years survival rate after operation)was used to evaluate the value of lymph node dissection in each group and guide the scope of lymph node dissection during operation.Results The positive rates of lymph nodes in patients with tumor infiltration depth T1-T3were 1.55%,36.5%and 23.8%respectively.The lymph node metastasis rate of bilateral recurrent laryngeal nerve was significantly higher than that of other groups and the right side was higher than that of the left side.Conclusion Bilateral parapharyngeal lymph nodes have the highest metastatic rate in esophageal squamous cell carcinoma,among which right parapharyngeal lymph node dissection can significantly improve the prognosis,while left parapharyngeal lymph node dissection is more necessary only at T2 and T3 stages.