隆突下淋巴结清扫在食管癌手术中的应用价值

Application value of subcarinal lymph node dissection in esophageal cancer surgery

目的:探讨隆突下淋巴结清扫在食管癌手术中的应用价值。方法:选取莆田学院附属医院2012年6月至2015年1月行手术治疗的食管癌患者240例,采用随机数字表法分为试验组(隆突下淋巴结清扫组,n=120例)和对照组(隆突下淋巴结未清扫组,n=120例)。统计试验组隆突下淋巴结清扫个数和隆突下淋巴结转移率,logistic回归分析试验组隆突下淋巴结转移的影响因素。比较两组患者的手术时间、术中出血量、术后并发症发生情况、术后住院时间、住院总费用及5年生存率。结果:试验组平均清扫隆突下淋巴结6.03枚,淋巴结转移率为18.33%(22/120)。试验组隆突下淋巴结转移率与隆突下淋巴结大小、肿瘤浸润深度、肿瘤部位、肿瘤长径有关。试验组手术时间为(271.76±69.48)min,长于对照组的(248.15±76.76)min(t=2.498,P=0.013);术中出血量为(250.95±79.26)mL,多于对照组的(202.13±84.87)mL(t=4.606,P<0.001);术后肺部感染发生率为40.00%(48/120),高于对照组的25.83%(31/120)(χ^(2)=7.533,P=0.004);术后住院时间为(19.72±9.41)d,长于对照组的(16.52±7.87)d(t=2.849,P=0.005);住院总费用为(77297.15±50955.57)元,高于对照组的(67506.22±11310.25)元(t=2.055,P=0.041)。试验组的5年生存率为44.20%(53/120),高于对照组的27.50%(33/120)(χ^(2)=8.784,P=0.003)。结论:食管癌患者隆突下淋巴结转移率低,其转移率与隆突下淋巴结大小、肿瘤浸润深度、肿瘤部位、肿瘤病理分期有关。对于胸中段、肿瘤浸润达食管肌层以上及隆突下淋巴结大小超过1.0 cm的食管癌患者应常规清扫该区域淋巴结,虽能延长手术操作时间、增加术后肺部感染发生率、延长住院时间、增加住院总费用,但能提高其5年生存率。

Objective To investigate the application value of subcarinal lymph node dissection in esophageal cancer surgery.Methods A total of 240 patients with esophageal cancer who received treatment in the Affiliated Hospital(Group)of Putian University from June 2012 to January 2015 were included in this study.They were randomly assigned to undergo subcarinal lymph node dissection(experimental group,n=120)or not(control group,n=120).The number of dissected subcarinal lymph nodes and the metastasis rate of subcarinal lymph node in the experimental group were determined.Logistic regression analysis was used to analyze the influential factors of subcarinal lymph node metastasis.Operation time,intraoperative blood loss,postoperative complications,postoperative hospital stay,total cost and 5-year survival rate were compared between the experimental and control groups.Results In the experimental group,the average number of dissected subcarinal lymph nodes was 6.03,and the metastasis rate of lymph nodes was 18.33%(22/120).The lymph node metastasis rate in the experimental group was related to the size of lymph node,the depth of tumor invasion,the location and length of tumor.Operation time in the experimental group was significantly longer than that in the control group[(271.76±69.48)min vs.(248.15±76.76)min,t=2.498,P=0.013].Intraoperative blood loss in the experimental group was more than that in the control group[(250.95±79.26)mL vs.(202.13±84.87)mL,t=4.606,P<0.001].The incidence of postoperative pulmonary infection in the experimental group was significantly higher than that in the control group[40.00%(48/120)vs.25.83%(31/120),χ^(2)=7.533,P=0.004].Postoperative hospital stay in the experimental group was longer than that in the control group[(19.72±9.41)d vs.(16.52±7.87)d,t=2.849,P=0.005).Total cost of hospitalization in the experimental group was greater than that in the control group[(77297.15±50955.57)yuan vs.(67506.22±11310.25)yuan,t=2.055,P=0.041).5-year survival rate in the experimental group was significantly higher than that in the control group[44.20%(53/120)vs.27.50%(33/120),χ^(2)=8.784,P=0.003).Conclusion The metastasis rate of subcarinal lymph nodes is low in patients with esophageal cancer,which is related to the size of subcarinal lymph nodes,the depth of tumor invasion,the location of tumor and the pathological stage of tumor.For patients with middle-thoracic segment esophageal cancer with tumor invasion above the muscular layer of the esophagus and the size of subcarinal lymph nodes greater than 1.0 cm,routine dissection of lymph nodes in this area can prolong operation time,increase the incidence of postoperative pulmonary infection,prolong the length of hospital stay and increase the total cost of hospitalization,but it can increase the 5-year survival rate.