三野淋巴清扫治疗晚期食管癌临床疗效探究.doc

三野淋巴清扫治疗晚期食管癌临床疗效探究【基金编号】广东省珠海市科技局资助项目（2011013） 【摘要】目的: 探讨三野淋巴清扫术治疗已有颈部淋巴转移晚期食管癌病人的疗效。方法:对50 例已有颈部淋巴转移晚期食管癌病人行颈部，胸部，上腹部三野淋巴清扫，术后予以放化疗，与同期单纯放化疗患者对比其生存质量，生存时间。结果:全组50 例颈部淋巴清扫病理示均有转移，无手术期死亡，肺部感染4 例；声带麻痹6 例，其中3 例并发肺部感染；颈部吻合口瘘4 例，术后病人生存质量，生存时间较单纯放化疗明显提高。结论:采用三野淋巴清扫术治疗已有颈部淋巴转移晚期食管癌病人，能达到很好的效果。 【关键词】三野淋巴清扫术；食管癌 【中图分类号】R735.1【文献标识码】A【文章编号】1044-5511（2011）11-0068-01 【Abstract】Objective to analyze the effectiveness and safety of 3-field lymphadenectomy for esophageal cancer with cevical lymph node metastasis. Methods 50 local advanced esophageal cancer patients meeting criterial of cevical lymph node metastasis received radical resection and thoracic, upper abdomenal and cervical lymphadenectomy, and received postoperative chemo-radiotherapy. We campared the life quality and survival time with other cohort receiving concurrent chemo-radiotherapy results cervical lymph node metastasis were pathologically proved in these 50 patients. There were no perioperative death, 4 pneumonia, 6 vocal cord paralysis, 4 cervical anastomosis leakage. 3-field lymphadenectomy resulted better life quality and longer survival time than patients received concurrent chemo-radiotherapy. Conclusions 3-field lymphadenectomy resulted in best effectiveness for the treatment of local advanced and cervical lymph node metastatic esophageal cancer 【Key words】3-field lymphadenectomy, esophageal cancer 食管癌的外科治疗是目前首选方法，但术后淋巴结转移复发是食管癌的重要死亡因素［1,2］，而上纵膈和颈部淋巴结有较高的转移率［3］。以往已有颈部淋巴结转移被视为食管癌晚期而放弃手术。有很多报道胸部中上段食管癌颈部淋巴结转移者三野清扫可取得较好外科疗效，有学者认为［4］颈部淋巴结应属于区域淋巴结，而非远处淋巴结。笔者所在医院对自2006 年9 月―2009 年9 月50 例胸部中上段食管癌颈部淋巴结转移者行三野淋巴结清扫食管癌切除术，术后予以放化疗，取得初步经验，现报道如下： 1 资料与方法 1．1病例资料:2006 年9 月～2009 年9 月共50 例病人接受三野清扫食管癌根治术，男28 例，女22 例，年龄41～72 岁，平均年龄（53.3±3.6）岁，原发灶长度3～8 cm，所有病例术前均行纤维胃镜及影像学检查，获得病理学诊断。病人入组条件为病变位于胸部中上段食管，术前均可触及颈部淋巴结肿大，无远处器官转移，心肺功能可耐受手术。 1.2 手术方法：左侧卧位，右前外侧切口，经第五肋间进胸，切断或切除奇静脉弓，探查游离病变食管，向上游离入胸顶，过锁骨上方，至颈段。向下游离至膈肌裂孔，牵拉下段食管可游离腹腔段至贲门 清除食管旁、下肺静脉旁、肺门、隆突、上腔静脉旁、上纵隔淋巴组织。于膈肌食管裂孔上方切断食管，以食管套封闭远端切口，结扎或缝闭远端切口，以10 号丝线长约