探讨食管癌根治术是否需要常规清扫隆突下淋巴结。

回顾性分析川北医学院附属医院2013年3月至2016年3月行食管癌根治术患者的临床资料，根据是否行隆突下淋巴结清扫分为清扫组(n＝294)和未清扫组(n＝308)两组。比较两组患者的基本特征，Logistic回归分析食管癌隆突下淋巴结转移的影响因素，并比较清扫组和未清扫组患者的围手术期差异。

共纳入病例602例，平均清扫淋巴结11.75枚，其中淋巴结转移202例(33.6%)。清扫组患者平均清扫隆突下淋巴结2.87枚，其中转移20例(6.8%)。单因素分析显示：Tis/T1、T2、T3、T4期食管癌隆突下淋巴结转移率分别为0、1.4%、10.2%、13.6%(χ²＝16.407，P < 0.01)；N0、N1、N2、N3期食管癌隆突下淋巴结转移率分别为0、12.9%、20.5%、60.0%(χ²＝46.099，P < 0.01)；肿瘤长度≤3.0 cm、3.1～5.0 cm、>5.0 cm食管癌隆突下淋巴结转移率分别为2.0%、7.5%、13.3%(χ²＝8.253，P < 0.05)；隆突下淋巴结转移与年龄、性别、手术路径、肿瘤位置、肿瘤分化程度以及淋巴结清扫数目无关(均P>0.05)。多因素分析显示：食管癌隆突下淋巴结转移与T分期及肿瘤浸润深度有关(均P<0.05)。清扫组患者肺部及胸腔并发症发生率高于未清扫组，手术时间长于未清扫组(均P< 0.05)。

食管癌隆突下淋巴结转移与肿瘤浸润深度及N分期有关。因此，对于胸段食管癌当肿瘤侵及食管纤维膜时建议行隆突下淋巴结清扫，但可能会增加肺部及胸腔并发症发生率并延长手术时间。

To investigate the value of routine subcarinal lymph node dissection in radical resection of esophageal cancer.

The clinical data of patients undergoing radical resection of esophageal cancer in Affiliated Hospital of North Sichuan Medical College between March 2013 and March 2016 were retrospectively analyzed. Patients were divided into dissection group (with subcarinal lymph node dissection, n=294) and non-dissection group (without subcarinal lymph node dissection, n=308). The basic characteristics were compared between two groups. The influencing factors of subcarinal lymph node metastasis were explored by Logistic regression analysis, and the perioperative parameters were compared between two groups.

A total of 602 patients were included, with an average of 11.75 dissected lymph nodes in each patient. There were 202 cases of lymph node metastasis, which accounted for 33.6%. The mean number of dissected lymph nodes in each patient in dissection group was 2.87, and there were 20 patients (6.8%) with lymph node metastasis in dissection group. Univariate analysis indicated that the rates of subcarinal lymph node metastasis in patients staged Tis/T1, T2, T3 and T4 were 0, 1.4%, 10.2% and 13.6%, respectively (χ²=16.407, P<0.01), the rates of subcarinal lymph node metastasis in those staged N0, N1, N2 and N3 were 0, 12.9%, 20.5% and 60.0%, respectively (χ²=46.099, P< 0.01), the rates of subcarinal lymph node metastasis in those with different length of esophageal cancers (≤3.0 cm, 3.1 to 5.0 cm, >5.0 cm) were 2.0%, 7.5% and 13.3%, respectively (χ²=8.253, P<0.05), and the rate of subcarinal lymph node metastasis was not significantly related to age, gender, tumor location, surgical path, tumor differentiation and number of dissected lymph nodes (P>0.05). Multivariate analysis indicated that T staging and infiltration depth of esophageal cancer were related to subcarinal lymph node metastasis (P<0.05). The incidence of pulmonary and thoracic cavity complications and operation time in dissection group were higher and longer than those in non-dissection group (P<0.05).

Tumor infiltration depth and N staging are related to subcarinal lymph node metastasis of esophageal cancer. Subcarinal lymph nodes may be dissected routinely in esophageal cancer patients with esophageal fiber membrane infiltration, however, it may also increase the incidence of complications and operation time.