南疆地区食管鳞癌患者隆突下钙化淋巴结转移相关因素及术式选择

The factors related to subcarinal calcified lymph node metastasis of esophageal squamous cell carcinoma patients in southern Xinjiang and selection of surgical methods

目的:探讨南疆地区食管癌患者钙化性隆突下淋巴结转移相关因素及术式选择。方法:回顾性分析2015年1月至2018年10月,于喀什地区第一人民医院胸外科行食管癌根治术治疗的196例食管鳞癌合并隆突下淋巴结钙化或趋于钙化的患者。根据术中隆突下淋巴结钙化严重程度是否行隆突下淋巴结清扫分为两组,隆突下淋巴结清扫组(168例)和隆突下淋巴结未清扫组(28例)。结果:单因素分析显示:患者年龄、性别、肿瘤部位、肿瘤分化程度与隆突下淋巴结转移无关(P>0.05),肿瘤长度、肿瘤T分期和N分期与隆突下淋巴结转移有关(P<0.05)。多因素分析显示:T分期和N分期与隆突下淋巴结转移有关(P<0.05),肿瘤的长度与隆突下淋巴结转移无关(P>0.05)。结论:针对南疆地区食管癌患者多合并隆突下淋巴结钙化的情况,对于肿瘤较小以及T、N分期较早的患者,可选择性清扫隆突下淋巴结或行隆突下淋巴结采样;而对于肿瘤较大以及T、N分期较晚的患者,应按诊疗规范行根治性隆突下淋巴结清除术。

Objective:To explore the factors related to subcarinal calcified lymph node metastasis of esophageal squamous cell carcinoma patients in southern Xinjiang and selection of surgical methods.Methods:196 cases of esophageal cancer radical surgery in the Department of Thoracic Surgery,First People’s Hospital of Kashgar,from January 2015 to October 2018 were retrospectirely analysed.Patients with esophageal squamous cell carcinoma and calcification or calcification were observed.According to the severity of calcification in the subcarinal lymph nodes,the subarachnoid lymph node dissection was divided into two groups,the subcarinal lymph node dissection group(168 cases)and the subcarinal lymph node uncleaned group(28 cases).Results:The results of univariate analysis showed that the age,gender,tumor site and tumor differentiation of the patients were not related to the metastasis of the subcarinal lymph nodes(P>0.05).The tumor length,tumor T stage and N stage were related to the subcarinal lymph node metastasis(P<0.05).Multivariate study results:T stage and N stage were associated with subcarinal lymph node metastasis(P<0.05),and tumor length was not associated with subcarinal lymph node metastasis(P>0.05).Conclusion:In the case of patients with esophageal cancer in southern Xinjiang,combined with calcification of the subcarinal lymph nodes,patients with small tumors and early T and N stages may be able to selectively clean the subcarinal lymph nodes.For patients with large tumors and late T and N stages,the subcarinal lymph nodes should be radically removed according to the standard of diagnosis and treatment.