食管癌术中左喉返神经淋巴结切除及临床意义

SURGICAL SKILL AND ITS CLINICAL SIGNIFICANCE OF RESECTING THE LYMPH NODE CHAIN OF LEFT RECURRENT LARYNGEAL NERVE IN OPERATION ESOPHAGEAL CARCINOMA

目的 :左喉返神经淋巴结链是胸段食管癌常见的淋巴转移部位 ,经右胸切口对该处淋巴结的切除国内文献尚未见报道 ,本文旨在介绍该淋巴结切除的手术方法 ,并初步探讨左喉返神经淋巴结切除的临床意义。方法 :2 0 0 0～ 2 0 0 2年间经右胸切口食管癌手术中行左喉返神经淋巴结切除 1 2 1例 ,回顾分析该组病例左喉返神经淋巴结的转移率 ,左喉返神经淋巴结切除的手术方法。结果 :共切除左喉返神经淋巴结 2 83个 ,查见肿瘤转移 88个 ,占31 .0 9% ;其中上段食管癌中切除 63个 ,肿瘤转移 2 5个 ,转移率 39.68% ;中段 2 0 3个 ,转移 41个 ,转移率 2 0 .2 0 % ;下段 1 7个 ,转移 3个 ,转移率 1 7.65 %。熟悉左喉返神经的解剖和比邻关系有利于淋巴结的顺利切除。结论 :食管癌左喉返神经淋巴结链转移较常见 ,可能是术后气管周围复发的主要原因。经右胸左喉返神经淋巴结切除手术过程不复杂 ,无明显的手术并发症 ,不显著增加手术时间 ,且理论上可减少肿瘤复发 ,提高病人五年生存率 ,有一定的推广价值。

Objective: Left recurrent laryngeal nerve lymph node metastasis is commonly found in thoracic oesophagus carcinoma. The goal of this study was to recommend the technique on how to remove the lymph node chain along left recurrent laryngeal nerve in right thoracotomy incisions, and to investigate the clinical significance of this operation. Method: A series of 121 patients with esophageal carcinoma who underwent left recurrent laryngeal nerve lymph node dissection during 2000～2002 was investigated retrospectively ,and the lymph node metastasis ratio along left recurrent laryngeal nerve was reviewed. Results: The overall lymph node metastasis ratio of left recurrent laryngeal nerve was 31.09%(88/283) , the lymph node metastasis ratio among the esophageal cancer located at superior, middle, and inferior segment was 39.68% (25/63) , 20.20%(41/203) , 17.65%(3/17) respectively. In technique of dissection for the lymph node chain of left recurrent laryngeal nerve, better exposure of the operation field, especially those along the left recurrent laryngeal nerve, is very important to the removal of lymph nodes. Conclusion: Metastasis to lymph node along the left recurrent laryngeal nerve is commonly found in carcinoma of the thoracic esophagus, and it is probably the main cause for tumor relapse. The technique of dissection for the lymph node chain of left recurrent laryngeal nerve is not difficult and is a safe procedure.Theoretically this operation can also decrease the tumor recurrence and thus significantly ameliorate the 5-years survive rate. So this technique is worth adopting routinely.