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目的探讨选择性三野淋巴结清扫的可行性和术后并发症的防治。方法应用彩超加CT对108例胸段食管癌进行常规术前检查,提示有下颈部淋巴结转移者实施三野淋巴结清扫术,共31例。结果31例中有下颈部淋巴结转移27例(87.1%),其中胸上段癌、中段癌、下段癌的转移率分别为83.3%、92.9%和80.0%(P>0.05),但在108例中的转移率为25.0%;喉返神经链淋巴结转移20例,转移率64.5%;术后3年生存率46.2%;手术死亡1例,术后并发症41.9%。结论彩超加CT判断下颈部淋巴结是否有转移是可行的,可将其列为胸段食管癌的常规术前检查;选择性三野淋巴结清扫降低了手术风险。
Objective To explore the feasibility of selective three-node lymph node dissection and prevention and treatment of postoperative complications. Methods The routine preoperative examination of 108 cases of thoracic esophageal cancer by color Doppler ultrasonography combined with CT showed that there were 31 cases undergoing lymphadenectomy with lower cervical lymph node dissection. Results There were 27 cases (87.1%) with metastasis of lower cervical lymph node in 31 cases. The metastasis rates of upper thoracic carcinoma, middle carcinoma and lower carcinoma were 83.3%, 92.9% and 80.0% respectively (P> 0.05) . The rate of metastasis was 25.0%. There were 20 cases of recurrent laryngeal nerve chain lymph node metastasis, the rate of metastasis was 64.5%. The 3-year survival rate was 46.2%. One case died of surgery and 41.9% of postoperative complications. Conclusions It is feasible to determine whether there is lymph node metastasis by color Doppler ultrasonography plus CT, which can be listed as the routine preoperative examination of thoracic esophageal cancer. The selective three-node lymphadenectomy reduces the operation risk.