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目的:探讨右胸入路三野清扫淋巴结治疗中晚期胸中段食管癌的临床疗效及对预后的影响。方法:回顾性分析我院2012年9月-2013年9月收治的中晚期胸中段食管癌者的临床资料,所有患者均采用右胸入路行Ivor-Lewis术,根据淋巴清扫范围方式分为二野组(n=37)、三野组(n=25)。比较两组淋巴清扫情况、术后并发症、复发转移及预后。结果:与二野组比较,三野组淋巴清扫数显著增加(P<0.05),上纵膈淋巴结转移率及总转移率显著升高(P<0.05);二野组喉返神经损伤的发生率显著低于三野组(P<0.05);二野组和三野组的复发率分别为43.2%、16.0%,二者比较差异有统计学意义(P<0.05);三野组中位DFS为19.7个月(95%CI:15.5~23.8),显著高于二野组中位DFS为16.8个月(95%CI:12.0~20.9)(P<0.05)。结论:右胸入路三野淋巴结清扫治疗中晚期胸中段食管癌患者是安全可行的,有助于彻底清除转移淋巴结,降低术后复发,改善预后。
Objective: To investigate the clinical effect of right chest approach and three-field lymphadenectomy in the treatment of moderate and advanced mid-thoracic esophageal cancer and its effect on prognosis. Methods: A retrospective analysis of our hospital from September 2012 to September 2013 admitted to the middle and advanced thoracic esophageal cancer clinical data, all patients were treated with right chest Ivor-Lewis approach, according to lymph node dissection range is divided into Second wild group (n = 37), San wild group (n = 25). The lymphadenectomy, postoperative complications, recurrence, metastasis and prognosis were compared between the two groups. Results: Compared with Erhuan group, the number of lymphadenectomy in Sanye group increased significantly (P <0.05), the rate of mediastinal lymph node metastasis and total metastasis increased significantly (P <0.05). The incidence of recurrent laryngeal nerve injury (P <0.05). The relapse rates of Erye and Sanye groups were 43.2% and 16.0%, respectively (P <0.05). The median DFS of Sanye group was 19.7 Month (95% CI: 15.5-23.8), which was significantly higher than that of the second group (16.8 months, 95% CI: 12.0-20.9) (P <0.05). Conclusion: It is feasible and safe to treat patients with middle and advanced thoracic esophageal carcinoma with right breast approach and three-node lymphadenectomy. It is helpful to completely remove metastatic lymph nodes, reduce postoperative recurrence and improve prognosis.