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目的:探讨下端食管癌淋巴结转移规律,评价胸腹联合食管癌根治术(IL组)与传统经左胸食管癌根治术(SW组)的治疗疗效。方法:回顾性分析119例胸下段食管鳞癌患者胸腹联合食管癌根治术和经左胸食管癌根治术的临床病理资料。结果:IL组平均清除淋巴结(21±7.7)个,淋巴结转移率为21.4%,显著高于SW组的(15.6±9.2)个(t=53.4,P<0.01)和17.1%,χ2=4.820,P=0.028。IL组的上纵隔淋巴结转移率(15.1%)和上腹部淋巴结转移率(17.6%)显著高于SW组的5.6%和9.0%,P<0.05;中、下纵隔淋巴结转移率与SW组比较差异无统计学意义,P>0.05。SW组手术时间平均约151.2min,低于IL组的185.0min(t=34.8,P<0.01),两组出血量和术后并发症比较差异无统计学意义,P>0.05。结论:上纵隔及上腹部区域是下胸段食管癌淋巴结转移的重要区域,Ivor-Lewis术式可清除更多数量及部位的淋巴结,特别是对于上纵及腹腔部位淋巴结的清除具有明显优势。
Objective: To investigate the rule of lymph node metastasis in lower esophageal cancer and evaluate the curative effect of thoracoabdominal combined radical resection of esophageal cancer (IL group) and traditional radical surgery of left thoracic esophageal cancer (SW group). Methods: A retrospective analysis of 119 cases of thoracic esophageal squamous cell carcinoma patients with thoracoabdominal combined esophageal cancer radical surgery and left thoracic esophageal cancer radical mastectomy clinical and pathological data. Results: The mean lymph node clearance (21 ± 7.7) and lymph node metastasis rate in IL group was significantly higher than that in SW group (15.6 ± 9.2) (t = 53.4, P <0.01) and 17.1% P = 0.028. The rates of mediastinal lymph node metastasis (15.1%) and upper abdomen lymph node metastasis (17.6%) in IL group were significantly higher than those in SW group (5.6% vs 9.0%, P <0.05) No statistical significance, P> 0.05. The mean operative time in SW group was 151.2min, which was lower than 185.0min in IL group (t = 34.8, P <0.01). There was no significant difference in bleeding volume and postoperative complications between two groups (P> 0.05). Conclusion: The upper mediastinum and the upper abdomen area are the important areas for lymph node metastasis of the lower thoracic esophagus. Ivor-Lewis technique can clear more lymph nodes and lymph nodes, especially for the clearance of the upper and the lower abdominal lymph nodes.