OBJECTIVE To explore the regular patterns of lymphatic metastasis in thoracic esophageal carcinoma （TEC） and the factors influencing these patterns. METHODS Data of 229 TEC patients who underwent radical esophag...OBJECTIVE To explore the regular patterns of lymphatic metastasis in thoracic esophageal carcinoma （TEC） and the factors influencing these patterns. METHODS Data of 229 TEC patients who underwent radical esophagectomy and thoracoabdominal 2-field lymphadenectomy were reviewed. Within this patient population, a total of 2458 lymph nodes were dissected during surgery. The distribution of the nodular metastasis rates （NMR） in various diseased regions in the esophageal carcinoma （EC） patients as well as factors influencing metastases such as the depth of tumor infiltration, tumor size, tumor morphology, and degree of tumor differentiation were analyzed. RESULTS i） Lymphatic metastasis （LM） occurred in 102 EC cases, and the lymphatic metastasis rate （LMR） was 44.5% （102/229）. The NMR was 9.5% （258/2458）. ii） The NMRs were 19.0%, 6.7%, 9.8% and 12.2% in the superior, middle and inferior mediastinum, and abdominal cavity, respectively, in patients with EC in the superior thoracic segment; 26.1%, 7.4%, 11.8% and 11.9% in the same sites of the mediastinum, respectively, in those with middle thoracic-segment EC; and 0%, 1.6%, 5.3%, and 10.0%, respectively, in the same sites in those with inferior thoracic EC. iii） The LMRs of the EC patients in stage-T1, T2, T3 and T4 were 28.6%, 43.8%, 47.6% and 31.3%, respectively, and the NMRs of the patients were 7.9%, 10.8%, 10.7% and 10.8%, respectively. There were no significant differences between the LMR and the NMR of the EC patients in stage T1 to T4 （X^2 = 2.733, P = 0.435 and X2 = 0.686, P = 0.876）. iv） The LMR of the patients with the length of tumor 〈 3 cm, 〉 3 cm and 〈 5 cm, and 〉 5 cm were 45.2%, 43.4% and 46.2%, respectively, and the NMR according to the same range of the tumor size above were 9.1%, 11.6% and 11.7%, respectively. There were no significant differences between the groups （X2 --- 0.094, P = 0.954 and X2 = 3.933, P = 0.140）. v） The NMRs of the medullary, ulcerative, fungoid and sclerotic-type EC were 14.0%, 9.6%, 4.3% and 18.3%, respectively （X^2 = 19.292, P = 0.000）, among which the NMR of the fungoid-type EC was the lowest. The LMRs were 42.5% and 75.0%, respectively in the cases with squamous cell carcinoma （SqCC） and poorly differentiated SqCC （X^2 = 4.852, P = 0.028）, and the NMRs were 9.5% and 18.6% correspondingly in the 2 groups （X^2 = 11.323, P = 0.001）. LM was commonly seen in the cases with poorly differentiated tumors. CONCLUSION Lymph node metastases of TEC spreads widely and can involve many regions. Metastasis can even be found in early stages of EC. Morphologic type and the degree of tumor differentiation are the main factors affecting the LM.展开更多
目的探索左右胸不同入路手术对胸中段老年食管癌患者P物质(SP)、神经肽Y(NPY)水平及肺功能的影响。方法选取我院2018年1月至2020年12月收治的89例胸中段老年食管癌患者作为研究对象,依照不同入路手术分为常规入路组和右胸入路组。常规...目的探索左右胸不同入路手术对胸中段老年食管癌患者P物质(SP)、神经肽Y(NPY)水平及肺功能的影响。方法选取我院2018年1月至2020年12月收治的89例胸中段老年食管癌患者作为研究对象,依照不同入路手术分为常规入路组和右胸入路组。常规入路组44例行经左胸两切口(左胸—颈部)入路手术,右胸入路组45例行经右胸3切口(上腹部—右胸—颈部)入路手术,对比两组患者围手术期指标、疼痛指标、肺功能、并发症情况。结果两组术后引流时间、总住院时间、术中所见淋巴结转移数水平比较差异无统计学意义(P>0.05);右胸入路组手术时间、术中出血量、淋巴结清扫数水平高于常规入路组(P<0.05)。两组患者术后72 h SP、NPY水平较术前升高,右胸入路组低于常规入路组(P<0.05)。两组患者术后1个月肺活量(VC)、用力肺活量(FVC)、1 s用力肺活量(FEV1)、最大通气量(MVV)水平较术前降低,右胸入路组高于常规入路组(P<0.05)。经Fisher确切概率法检验,右胸入路组并发症发生率11.11%(5/45)与常规入路组6.82%(3/44)比较,差异无统计学意义(P>0.05)。结论与左胸入路手术相比,右胸入路手术的手术时间较长,术中出血量较多,但淋巴结清扫数高,可调节胸中段老年食管癌患者肺功能,改善疼痛指标,有良好安全性。展开更多
基金supported by a grant from the Hebei Provincial Foundation for the Subjects with High Scholarship and Creative Research Potential in Ordinary Colleges and Universities,China (No.52,2005)
文摘OBJECTIVE To explore the regular patterns of lymphatic metastasis in thoracic esophageal carcinoma （TEC） and the factors influencing these patterns. METHODS Data of 229 TEC patients who underwent radical esophagectomy and thoracoabdominal 2-field lymphadenectomy were reviewed. Within this patient population, a total of 2458 lymph nodes were dissected during surgery. The distribution of the nodular metastasis rates （NMR） in various diseased regions in the esophageal carcinoma （EC） patients as well as factors influencing metastases such as the depth of tumor infiltration, tumor size, tumor morphology, and degree of tumor differentiation were analyzed. RESULTS i） Lymphatic metastasis （LM） occurred in 102 EC cases, and the lymphatic metastasis rate （LMR） was 44.5% （102/229）. The NMR was 9.5% （258/2458）. ii） The NMRs were 19.0%, 6.7%, 9.8% and 12.2% in the superior, middle and inferior mediastinum, and abdominal cavity, respectively, in patients with EC in the superior thoracic segment; 26.1%, 7.4%, 11.8% and 11.9% in the same sites of the mediastinum, respectively, in those with middle thoracic-segment EC; and 0%, 1.6%, 5.3%, and 10.0%, respectively, in the same sites in those with inferior thoracic EC. iii） The LMRs of the EC patients in stage-T1, T2, T3 and T4 were 28.6%, 43.8%, 47.6% and 31.3%, respectively, and the NMRs of the patients were 7.9%, 10.8%, 10.7% and 10.8%, respectively. There were no significant differences between the LMR and the NMR of the EC patients in stage T1 to T4 （X^2 = 2.733, P = 0.435 and X2 = 0.686, P = 0.876）. iv） The LMR of the patients with the length of tumor 〈 3 cm, 〉 3 cm and 〈 5 cm, and 〉 5 cm were 45.2%, 43.4% and 46.2%, respectively, and the NMR according to the same range of the tumor size above were 9.1%, 11.6% and 11.7%, respectively. There were no significant differences between the groups （X2 --- 0.094, P = 0.954 and X2 = 3.933, P = 0.140）. v） The NMRs of the medullary, ulcerative, fungoid and sclerotic-type EC were 14.0%, 9.6%, 4.3% and 18.3%, respectively （X^2 = 19.292, P = 0.000）, among which the NMR of the fungoid-type EC was the lowest. The LMRs were 42.5% and 75.0%, respectively in the cases with squamous cell carcinoma （SqCC） and poorly differentiated SqCC （X^2 = 4.852, P = 0.028）, and the NMRs were 9.5% and 18.6% correspondingly in the 2 groups （X^2 = 11.323, P = 0.001）. LM was commonly seen in the cases with poorly differentiated tumors. CONCLUSION Lymph node metastases of TEC spreads widely and can involve many regions. Metastasis can even be found in early stages of EC. Morphologic type and the degree of tumor differentiation are the main factors affecting the LM.
文摘目的探索左右胸不同入路手术对胸中段老年食管癌患者P物质(SP)、神经肽Y(NPY)水平及肺功能的影响。方法选取我院2018年1月至2020年12月收治的89例胸中段老年食管癌患者作为研究对象,依照不同入路手术分为常规入路组和右胸入路组。常规入路组44例行经左胸两切口(左胸—颈部)入路手术,右胸入路组45例行经右胸3切口(上腹部—右胸—颈部)入路手术,对比两组患者围手术期指标、疼痛指标、肺功能、并发症情况。结果两组术后引流时间、总住院时间、术中所见淋巴结转移数水平比较差异无统计学意义(P>0.05);右胸入路组手术时间、术中出血量、淋巴结清扫数水平高于常规入路组(P<0.05)。两组患者术后72 h SP、NPY水平较术前升高,右胸入路组低于常规入路组(P<0.05)。两组患者术后1个月肺活量(VC)、用力肺活量(FVC)、1 s用力肺活量(FEV1)、最大通气量(MVV)水平较术前降低,右胸入路组高于常规入路组(P<0.05)。经Fisher确切概率法检验,右胸入路组并发症发生率11.11%(5/45)与常规入路组6.82%(3/44)比较,差异无统计学意义(P>0.05)。结论与左胸入路手术相比,右胸入路手术的手术时间较长,术中出血量较多,但淋巴结清扫数高,可调节胸中段老年食管癌患者肺功能,改善疼痛指标,有良好安全性。
