食管癌根治性手术中淋巴结清扫范围对预后的影响

Influence of extent of lymph node dissection on prognosis of radical operation for esophageal carcinoma

目的研究食管癌根治性手术中淋巴结清扫范围对预后的影响。方法随机对照研究。抽取2021年3月至2023年2月于新乡市中心医院接受手术治疗的126例食管癌患者作为研究对象,按随机数字表法分为对照组和观察组,每组63例。对照组患者行二野淋巴结清扫术,观察组患者行三野淋巴结清扫术。比较两组血清乳酸脱氢酶(LDH)、一氧化氮(NO)、一氧化氮合成酶(NOS)、癌胚抗原(CEA)、可溶性白细胞介素-2受体(SIL-2R)、角化素蛋白片段19(Cyfra2I-1)、鳞状细胞癌相关性抗原(SCC)水平,比较两组术后并发症及淋巴结转移情况。结果术后,两组LDH、NOS、CEA水平均低于术前,NO水平高于术前(P<0.05),且观察组LDH、NOS及CEA水平低于对照组,NO水平高于对照组(P<0.05)。术后,SIL-2R、Cyfra2I-1及SCC水平均低于术前(P均<0.05),且观察组低于对照组(P<0.05)。观察组术后并发症发生率(23.80%,15/63)高于对照组(9.52%,6/63),淋巴结转移发生率(4.76%,3/63)低于对照组(17.46%,11/63),P<0.05。结论食管癌患者根治性手术中采取三野淋巴结清扫对淋巴结清扫更彻底,能够有效降低淋巴结转移及复发率,提高患者生存率。

Objective To study the influence of the extent of lymph node dissection on the prognosis of patients with esophageal carcinoma undergoing radical operation.Methods This study was a randomized controlled study.A total of 126 patients with esophageal carcinoma who underwent surgical treatment in Xinxiang Central Hospital from March 2021 to February 2023 were selected as the study subjects.And they were divide into control group and observation group according to random number table method,with 63 cases in each group.Patients in the control group underwent two-field lymph node dissection,while patients in the observation group underwent three-field lymph node dissection.The levels of lactate dehydrogenase(LDH),nitric oxide(NO),nitric oxide synthase(NOS),carcinoembryonic antigen(CEA),soluble interleukin-2 receptor(SIL-2R),keratin protein fragment 19(Cyfra2I-1)and squamous cell carcinoma associated antigen(SCC)were compared between the two groups.The postoperative complications and lymph node metastasis of the two groups were compared.Results After surgery,the levels of LDH,NOS and CEA in both groups decreased,while the level of NO in the both groups increased,compared with preoperative levels(P<0.05).Additionally,the levels of LDH,NOS,and CEA in the observation group were lower than those in the control group,while the level of NO was higher than that in the control group after treatment(P<0.05).After surgery,the levels of SIL-2R,Cyfra2I-1 and SCC in the two groups decreased,compared with preoperative levels(all P<0.05),and the observation group had lower levels of SIL-2R,Cyfra2I-1 and SCC than the control group(P<0.05).The incidence of postoperative complications in the observation group(23.80%,15/63)was higher than that in the control group(9.52%,6/63),while the incidence of lymph node metastasis in the observation group(4.76%,3/63)was lower than that in the control group(17.46%,11/63),P<0.05.Conclusions Three-field lymph node dissection is more effective in radical operation for esophageal carcinoma,which can reduce the rate of lymph node metastasis and recurrence,and improve the survival rate of patients.