胸段食管癌腹腔动脉干区淋巴结广泛清扫的临床意义.DOCVIP

临床医学论文-胸段食管癌腹腔动脉干区淋巴结广泛清扫的临床意义 ???????????? 作者：王洪江，庞作良, 斯坎达尔·阿布力孜, 孙伟, 瓦热斯江·依不拉音, 范志勤，薛峰 【摘要】? 目的了解胸段食管癌腹腔动脉干区淋巴结的转移特点及对预后的影响，探讨合理的腹腔动脉干区淋巴结清扫范围。方法对241例手术切除胸段食管癌患者的临床资料进行回顾性分析。结果腹腔淋巴结转移率32.4%，转移度9.8%。肝总动脉旁、腹腔动脉旁、肝十二指肠韧带内淋巴结转移度分别为6.6%、6.9%和6.3%。影响腹腔淋巴结转移的因素为肿瘤部位、侵润深度及组织分化程度，肿瘤长度则影响不大。患者术后3年腹腔局部复发率为5.4%。有腹腔淋巴结转移患者的术后3年生存率为42.3%，低于无淋巴结转移患者的70.6%(Ｐ0.01)。 结论腹腔淋巴结转移是影响食管癌切除患者预后的一个主要因素，对腹腔动脉干区淋巴结的广泛清扫可以降低术后的局部复发率。 【关键词】? 食管肿瘤；腹腔动脉干；淋巴结清扫术；预后 　　Clinical Significance for WideExcision of? Celiac Trunk Lymph Node on Thoracic Esophageal Carcinoma 　　Abstract：Objective To understand characteristics of celiac trunk lymphnode metastases of thoracic esophageal carcinoma and their influence on prognosis of the patients, and to investigate a reasonable range for regional celiac trunk lymphnode clearance. MethodsClinical specimens of 241 patients receiving resection of a thoracic esophageal carcinoma were analyzed retrospectively. ResultsThe rate of the patient celiac lymphnode metastases was 32.4%(78/241), and of the lymph nodes examined 9.8% were found to have metastasis. The extent of metastases adjacent to the common hepatic artery and celiac trunk and within the hepatoduodenal ligaments was 6.6%, 6.9%? and 6.3%, respectively. The tumor site, extent of invasion and level of cell differentiation were the factors influencing lymphnode metastases, but they were unrelated to the length of the tumor. The over all rate of regional celiac recurrence for the patients 3 years after operation was 5.4%. The 3year survivals for the patients with metastases of the celiac lymph nodes was 42.3%, which was lower compared to the nonmetastatic patients (70.6%)(0.01). ConclusionCeliac lymphnode metastases are one of key factors affecting the prognosis of the patients receiving resection of esophageal cancer, and extensive clearance of the celiactrunk lymph nodes can reduce the rate of postoperative regional metastases. 　　Key words：Esophageal neoplasms; Celiac trunk; lymphadenectomy;? Progno