作　　者： (邓亮）; (王雪海）;

机构地区： 四川省绵阳市安州区人民医院,622651

出　　处： 《实用癌症杂志》 2017年第9期1478-1481,共4页

摘　　要： 目的探讨不同淋巴结清扫方式治疗胸中上段食管癌的临床效果及对患者预后的影响。方法将134例胸中上段食管癌患者按淋巴结清扫方式不同分为观察组(56例)和对照组(78例),观察组行三野淋巴结清扫术,对照组行二野淋巴结清扫术。比较两组患者术后淋巴结病理检查结果、术后并发症情况及术后随访情况,检测两组患者术前及术后4个月乳酸脱氢酶(LDH)、一氧化氮(NO)、一氧化氮合成酶(NOS)、癌胚抗原(CEA)水平。结果观察组平均清扫淋巴结数(44.3±6.9)枚/例,淋巴结转移度为10.9%,对照组平均清扫淋巴结数(38.3±5.4)枚/例,淋巴结转移度为12.0%,两组比较差异无统计学意义(P>0.05);观察组淋巴结转移率为60.7%,显著高于对照组的42.3%(P<0.05);且观察组有较高的颈部淋巴结转移率(21.4%)和上纵隔淋巴结转移率(33.9%),但与对照组上纵隔淋巴结转移率(30.8%)比较差异无统计学意义(P>0.05)。两组术后喉返神经损伤、吻合口瘘、呼吸系统并发症、心血管并发症及围术期死亡率比较差异均无统计学意义(P>0.05);术后4个月,观察组LDH、NOS、CEA水平较对照组均显著降低(P<0.05),NO水平较对照组显著升高(P<0.05);观察组术后1年生存率为96.3%,显著高于对照组的85.5%(P<0.05);观察组术后1年颈部淋巴结复发率为1.9%,显著低于对照组的11.8%(P<0.05)。结论三野淋巴结清扫术较二野淋巴结清扫术能更彻底清除颈部及上纵隔淋巴结,有利于提高胸中上段食管癌手术根治性和术后分期,减少术后局部复发,改善患者预后。 Objective To investigate the effect of different methods of lymph node dissection on prognosis of patients with thoracic esophageal carcinoma. Methods 134 cases of patients with thoracic esophageal carcinoma with lymph node dissection were divided into the observation group（ 56 cases） and the control group（ 78 cases）. The observation group underwent 3-field lymph node dissection,the control group underwent 2-field lymph node dissection. The postoperative lymph node pathological examination results,postoperative complications and postoperative follow-up were compared between the 2 groups. The levels of CEA,NO,NOS and LDH were detected before and after operation in the 2 groups. Results The average number of lymph nodes in the observation group（ 44. 3 ± 6. 9）,the degree of lymph node metastasis was 10. 9%; The average number of lymph nodes in the control group（ 38. 3 ± 5. 4）,the degree of lymph node metastasis was 12%. There was no significant difference between the 2groups（ P〈0. 05）; The lymph node metastasis rate（ 60. 7%） in the observation group was significantly higher than that of the control group（ 42. 3%）（ P〈0. 05）; The observation group cervical lymph node metastatic rate was 21. 4 %; There was no significant difference between the upper mediastinal lymph node metastasis rate（ 33. 9%） in the observation group and the control group（ 30. 8%）（ P〈0. 05）; There was no significant difference in postoperative recurrent laryngeal nerve injury,anastomotic leakage,respiratory system complications,cardiovascular complications and perioperative mortality in the 2 groups（ P〈0. 05）; After 4 months,the levels of LDH,NOS and CEA in the observation group were significantly lower than those of the control group（ P〈0. 05）,and the level of NO was significantly higher than that of the control group（ P〈0. 05）; The postoperative 1-year survival rate（ 96. 3%） in the observation group was significantly higher than that of the control group（ 85. 5%）（ P�

关 键 词： 胸中上段食管癌 三野淋巴结清扫术 二野淋巴结清扫术 预后