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中华胸部外科电子杂志

中华胸部外科电子杂志 ›› 2014, Vol. 01 ›› Issue (01) : 35 -40. doi: 10.3877/cma.j.issn.2095-8773.2014.01.008

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论著

选择性三野淋巴结清扫术治疗胸段食管鳞癌的临床研究
马可1, 王祥1, 肖文光1, 韩泳涛1, 彭林1,†()   
  1. 1. 610041　成都，四川省肿瘤医院胸外科
  • 收稿日期:2014-08-24 出版日期:2014-11-28
  • 通信作者: 彭林

Clinical research of selective three-field lymphadenectomy for thoracic esophageal squamous cell carcinoma

Ke Ma1, Xiang Wang1, Wenguang Xiao1, Yongtao Han1, Lin Peng1,†()   

  1. 1. Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu 610041, China
  • Received:2014-08-24 Published:2014-11-28
  • Corresponding author: Lin Peng
  • About author:
    Corresponding author: Peng Lin, Email:
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马可, 王祥, 肖文光, 韩泳涛, 彭林. 选择性三野淋巴结清扫术治疗胸段食管鳞癌的临床研究[J]. 中华胸部外科电子杂志, 2014, 01(01): 35-40.

Ke Ma, Xiang Wang, Wenguang Xiao, Yongtao Han, Lin Peng. Clinical research of selective three-field lymphadenectomy for thoracic esophageal squamous cell carcinoma[J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2014, 01(01): 35-40.

目的

分析行选择性三野淋巴结清扫术对胸段食管鳞癌患者的预后影响。

方法

2009年6月至2012年9月，四川省肿瘤医院对127例胸段食管癌患者根据肿瘤的位置、外侵程度、术前颈部超声检查结果，进行选择性三野淋巴结清扫。全组共127例患者，其中上段49例；中段67例；下段11例；Ⅰ期2例，Ⅱ期26例，Ⅲ期99例。

结果

127例患者共清扫淋巴结4963枚，平均每例清扫淋巴结39.3枚；手术时间(325.6±9.3)min，出血量(316.0±18.7)ml。术后76例患者发生并发症，发生率为59.8%(76/127)病死率为1.6%(2/127)。选择性三野淋巴结清扫术后喉返神经旁淋巴结转移率40.2%(51/127)；颈部淋巴结转移率55.9%(71/127)，其中，胸中下段食管鳞癌颈部淋巴结转移与喉返神经转移显著相关(χ2＝0.005，P＝0.006)。全组中位生存时间(35.0±1.9)个月，3年生存率51.8%。其中Ⅱ期中位生存时间(42.1±3.4)个月，3年生存率74.5%；Ⅲ期生存时间(32.3±2.0)个月，3年生存率44.8%，两组间比较差异有统计学意义(χ2＝3.940，P＝0.047)。颈部淋巴结阳性患者的中位生存时间(26.2±2.1)个月，3年生存率34.9%；阴性患者中位生存时间(41.5±2.3)个月，3年生存率67.6%，差异有统计学意义(χ2＝15.283，P<0.001)。

结论

选择性三野淋巴结清扫术是一种安全可行、可提高颈部淋巴结清扫率，同时又能筛选出潜在获益患者、延长生存的手术方式。

关键词: 食管肿瘤，淋巴结转移, 三野淋巴结清扫术, 食管肿瘤，并发症
Objective

To analyse the clinical outcomes of selective three-field lymphadenectomy for thoracic esophageal squamous carcinoma.

Methods

From June 2009 to September 2012, 127 patients with esophageal squamous cell carcinoma received selective three-field lymphadenectomy according to tumor location, invasion degree and the results of preoperative cervical ultrasonography. Of the 127 cases of esophageal squamous cell carcinoma, 49 cases of tumor located in the upper third, 67 in the middle third, and the rest 11 in the lower third. According to the TNM staging, there were 2 patients in stage Ⅰ, 26 in stage Ⅱ and 99 in stage Ⅲ.

Results

A total of 4963 lymphatic nodes were detected, and the average number of resected lymphatic nodes was 39.3 for one case. The mean duration of operation was (325.6±9.3)min, and the mean volume of bleeding was (316.0±18.7)ml. The incidence of postoperative complications and motality were 59.8%(76/127) and 1.6%(2/127), respectively. The metastasis rate of laryngeal recurrent nerve lymph node was 40.2% (51/127), and the metastasis rate of cervical lymph node was 55.9%(71/127). In patients with middle or lower esophageal cancer, the incidence of cervical lymph node metastasis was significantly related to that of laryngeal recurrent nerve lymph node metastasis(χ2=0.005, P=0.006). The overall median survival time was (35.0±1.9) months, and the 3-year survival rate was 51.8%. The median survival time and 3-year survival rate of patients in stage Ⅱ were (42.1±3.4) months and 74.5%, respectively, those of patients in stage Ⅲ were (32.3±2.0) months and 44.8%, respectively, and there were significant differences between these two groups of patients(χ2=3.940, P=0.047). The median survival time and 3-year survival rate of cervical lymph node-positive patients were (26.2±2.1) months and 34.9%, respectively, those of cervical lymph node-negative patients were (41.5±2.3) months and 67.6%, respectively, and there were significant differences between these two groups of patients(χ2=15.283, P<0.001).

Conclusion

Selective three-field lymphadenectomy is a safe and feasible method which could improve the efficiency of metastatic cervical lymph node dissection, screen out potential patients who can benefit from the procedure, and prolong the survival time.

Key words: Esophageal tumor, Lymphatic metastasis, Three-field lymphadenectomy, Esophageal tumor, Complications
表1 行三野淋巴结清扫术的胸段食管鳞癌患者基线资料
项目 例数 百分比
性别 ? ?
? 男性 92 72.4
? 女性 35 27.6
肿瘤部位 ? ?
? 胸上段癌 49 38.6
? 胸中段癌 67 52.7
? 胸下段癌 11 8.7
术后病理分期 ? ?
? T分期 ? ?
? ? T1 3 2.4
? ? T2 13 10.2
? ? T3 105 82.7
? ? T4 6 4.7
? N分期 ? ?
? ? N0 27 21.3
? ? N1 46 36.2
? ? N2 39 30.7
? ? N3 15 11.8
? TNM分期 ? ?
? ? Ⅰ 2 1.5
? ? Ⅱ 26 20.5
? ? Ⅲ 99 78.0
表2 胸段食管鳞癌患者选择性三野淋巴结术后并发症发生情况
术后并发症 例数 发生率(%)
肺部感染 26 20.5
出血 1 0.8
吻合口瘘 9 7.1
暂时性喉返神经麻痹 15 11.8
永久性声音嘶哑 3 2.4
急性肾功能衰竭 1 0.7
心血管并发症 21 16.5
合计 76 59.8
表3 行三野淋巴结清扫术的胸段食管鳞癌患者各区域淋巴结转移情况[例(%)]
肿瘤位置 例数 颈部淋巴结 纵隔淋巴结 上腹淋巴结
上纵隔淋巴结 中纵隔淋巴结 下纵隔淋巴结
胸上段 49 27(55.1) 18(36.7) 13(26.5) 3(6.1) 9(18.4)
胸中段 67 40(59.7) 39(58.2) 33(49.3) 9(13.4) 25(37.3)
胸下段 11 4(36.4) 3(27.3) 4(36.4) 2(18.2) 7(63.6)
合计 127 71(55.9) 59(46.5) 40(31.4) 15(11.8) 41(32.3)
表4 行三野淋巴结清扫术的胸段食管鳞癌患者喉返神经旁淋巴结与颈部淋巴结转移关系[例(%)]
肿瘤位置 例数 颈部淋巴结转移 χ 2值 P值
喉返神经旁淋巴结(＋) 喉返神经旁淋巴结(－)
胸上段 49 11/14(78.6%) 16/35(45.7%) 0.037 0.057
胸中、下段 78 27/37(73%) 17/41(41.5%) 0.005 0.006
合计 127 38/51(74.5%) 33/76(43.4%) 0.001 0.001
图1 胸段食管鳞癌患者选择行三野淋巴结清扫术后全组生存曲线
图2 胸段食管鳞癌患者选择性三野淋巴结清扫术后Ⅱ期和Ⅲ期患者的生存曲线
图3 选择性三野淋巴结清扫术后颈部淋巴结转移患者的生存曲线
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