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目的探讨胸段食管癌淋巴结转移的特点,指导食管癌淋巴结清除术及为术后综合治疗方案的制定提供依据。方法回顾性分析2002年1月至2004年12月河南省肿瘤医院胸外科收治的623例胸段食管癌患者的手术及病理资料,分析其淋巴结转移特点。结果全组共清除3689组淋巴结(8603枚),淋巴结转移率47.2%,淋巴结转移度10.3%;Tis期食管癌无淋巴结转移,T1期以后各期食管癌均可见淋巴结转移。不同T分期胸段食管癌间,淋巴结转移率和转移度差异均有统计学意义(χ2=38.407,P=0.000和χ2=118.438,P=0.000);随T分期增加,淋巴结转移率和转移度均增加,两者间存在显著相关关系(r=1,P=0.000;r=1,P=0.000);不同病理类型的胸段食管癌间,其淋巴结转移率差异并无统计学意义(χ2=6.284,P=0.179),而淋巴结转移度差异存在统计学意义(χ2=84.577,P=0.000),食管腺鳞癌、腺癌、小细胞癌的淋巴结转移率及转移度均明显高于食管鳞癌;食管癌淋巴结转移具有上下双向性和跳跃性;各段食管癌均可以发生腹腔淋巴结转移,胸下段食管癌腹腔淋巴结转移率和转移度最高。结论食管癌淋巴结清除应适度,应重视对腹腔淋巴结的清除;在保证手术的相对彻底性的基础上,根据淋巴结转移趋势及其他一些指标,尽早接受合理的多学科综合治疗才应该是食管癌治疗的方向。
Objective To investigate the characteristics of lymph node metastasis in thoracic esophageal cancer and to guide the lymphadenectomy of esophageal cancer and to provide the basis for the development of comprehensive treatment plan. Methods Retrospective analysis of 623 cases of thoracic esophageal cancer patients admitted to Department of Thoracic Surgery, Henan Tumor Hospital from January 2002 to December 2004 retrospectively analyzed the characteristics of lymph node metastasis. Results A total of 3689 lymph nodes (8603) were removed in this study. The rate of lymph node metastasis was 47.2% and the rate of lymph node metastasis was 10.3%. No lymph node metastasis was found in Tis stage esophageal cancer. Lymph node metastasis was observed in all stages of esophageal cancer after T1 stage. The differences of lymph node metastasis and lymph node metastasis between different T stages of esophageal cancer were statistically significant (χ2 = 38.407, P = 0.000 and χ2 = 118.438, P = 0.000). With the increase of T stage, lymph node metastasis rate and metastasis (R = 1, P = 0.000; r = 1, P = 0.000). There was no significant difference in lymph node metastasis rate between different pathological types of thoracic esophageal cancer (χ2 = 6.284, P = 0.179). There was significant difference in the degree of lymph node metastasis (χ2 = 84.577, P = 0.000). The rates of lymph node metastasis and metastasis of esophageal adenosquamous carcinoma, adenocarcinoma and small cell carcinoma were significantly higher than those of esophagus Squamous cell carcinoma; lymph node metastasis of esophageal carcinoma has up and down bidirectionality and jumping; all stages of esophageal cancer can occur abdominal lymph node metastasis, subcutaneous esophageal cancer of the thoracic lymph node metastasis rate and the highest degree of metastasis. Conclusion Lymphadenectasis of esophageal cancer should be considered moderately and attention should be paid to the clearance of peritoneal lymph nodes. On the basis of ensuring the relative thoroughness of operation, according to the trend of lymph node metastasis and some other indicators, it should be esophageal cancer treatment as soon as possible after receiving appropriate multidisciplinary comprehensive treatment The direction of