胸段食管癌重点清扫淋巴结的临床病理特点及预后分析.pdf

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1、·临床论著·胸段食管癌重点清扫淋巴结的临床病理特点及预后分析陈远岷刘德森潘琪黄明芳黄重庆【摘要】目的探讨手术重点清扫淋巴结的临床病理特点及预后，为规范化清扫提供参考。方法对515例胸段食管癌手术患者的临床资料进行分析，重点研究隆突下、食管旁、胃左动脉旁三组重点清扫淋巴结与临床病理因素间的单因素和多因素分析及预后情况。结果单因素和多因素分析显示：隆突下淋巴结转移与肿瘤长度、分化程度和浸润深度有关(P

2、旁淋巴结的清扫组与未清扫组相比，其1、3、5年生存率均有显著差异(P<0．05)。结论胸段食管癌应尽可能对转移率较高的食管旁和胃左动脉旁淋巴结清扫彻底。对病变侵及食管全层或病变长度>3cm的患者应常规实施隆突下淋巴结的彻底清扫。在N1～3患者中，行食管旁、胃左动脉旁淋巴结清扫能提高患者的生存率。【关键词】食管肿瘤；淋巴转移；预后ThecHnicopathologiccharacteristicandprognosisanalysisoflymphadenectomyinthoracicesophagealcarcinomaChenYuanmin，LiuDesen，PanQi,H

3、uangMingfang,HuangChongqing．DepartmentofThoracicSurgery,TumorHospitalofGuangxiMedicalUniversity,Nanning530021，ChinaCorrespondingauthor．"LiuDesen,Email：desenliu57@hotmail,com[Abstract]ObjectiveTostudytheclinicopathologiccharacteristicandprognosisstatusandprovidethereferencesforstandardlymphad

4、enectomy．MethodsTheclinicaldataof515patients、】l，imthoracicesophagealcarcinomawereanalyzedtogetknowledgeoftherelationshipbetweenlymphadenectomyandclinicopathologiccharacteristicandprognosisstatusinsubcarinal，para-esophagealandleftgastricartery．ResultsUnivariateandmultivariateanalysisshowedtha

5、tsubcarinallymphnodemetastasiswassignificantlyassociatedwithtumorsize，degreeofdiferentiationanddepthofinvasion，<0．05)．Thepara-esophageallymphnodemetastasiswassignificantlyassociated、ⅣimdepthofinvasionandleRgastricarterylymphnodemetastasiswasalsosignificantlyassociated、)lril1ltumorlocation．tu

6、mordiferentiationanddepthofinvasion(P<0．05)．ForN1-N3patients，thesurvivalanalysisshowedthattherewasobviousdiferenceinone—year’three—yearandfive—yearsurvivalratebetweenpatientswhoconductedlymphadenectomyofpara—esophagus，leRgastricarteryandpatientswhodidnotperformthose．ConclusionsBecauseoftheir

7、hi【ghmetastasisrate，thoracicesophagealcarcinomashouldbeconductedlymphadenectomyinpara—esophagusandleRgastricarteryasfaraspossible．Thesubcarinallymphadenectomyshouldbeconductedinpatientswho’Sfullthicknessofesophagealhavebeeninvadedor1who’Slesionleng