方文涛教授食管癌淋巴转移规律及手术方式探讨.pptxVIP

食管癌淋巴转移规律及手术方式探讨上海市胸科医院食管癌淋巴转移特点1. 淋巴转移先于血路转移解剖基础：黏膜下层丰富淋巴管临床经验：早期淋巴转移、频率随侵润深度升高侵犯至粘膜下层，淋巴结转移率即可达18～33％侵犯至外膜层以后淋巴结转移率更高达78～89％Evidence美国著名临床中心经验， Univ. South California T. R. DeMeester 1994.肿瘤浸润程度 (pT) 淋巴节转移率（%）T133T267T3以上89Evidence欧洲著名临床中心经验，德国R.Siewert 1995.肿瘤浸润深度( pT) 淋巴结转移率（%）T1a（粘膜层）0T1b（粘膜下层）18T2（肌层）77T3（外膜层）83T4（外侵周围器官）96Evidence日本全国96家医院调查结果，K.Isono 1991.肿瘤浸润深度 (pT) 区域淋巴结转移率（%）粘膜层(Tis)0粘膜固有层(T1a)30粘膜下层(T1b)51.7肌层(T2)67.9外膜层(T3)78外侵周围器官(T4)83上海市胸科医院系统性淋巴结清扫结果 肿瘤浸润深度 (pT) pN1 频度 (%) pTis-T1a0pT1b45.5%pT250%pT364.5%pT459.1%食管癌淋巴转移特点2. 早期、跳跃式的淋巴转移解剖基础：淋巴管的垂直纵向交通比水平方向的淋巴引流更为丰富临床经验：Evidence远离原发病灶的跳跃淋巴结转移（10%）黏膜下转移（13.5％）Kato H. Int J Cancer 1992;50:49-52.上海市胸科医院系统性淋巴结清扫结果肿瘤浸润深度 (pT) 淋巴管侵犯 (%)粘膜下转移 (%)pTis-T1a00pT1b9.10pT24.84.8pT313.54.3pT44.52.3Total9.73.6食管癌淋巴转移特点黏膜下转移食管癌淋巴转移特点3. 淋巴转移途径胸段食管癌的转移高发淋巴结组群为颈胸交界部的喉返神经链淋巴结贲门－胃左动脉－腹腔动脉链淋巴结以隆突下淋巴结为中心的食管旁淋巴结Akiyama H, et al. Ann Surg 1994;220:364-73.Kato H, et al. J Surg Oncol 1991;48:106-11.Akiyama H. Color Atlas of Surgical Anatomy for Esophageal Cancer. 1992. 上海市胸科医院系统性淋巴结清扫结果原发肿瘤部位与各区域淋巴结转移率（%）：肿瘤位置 颈淋巴结 纵隔淋巴结 上腹淋巴结上纵隔 中纵隔 下纵隔 胸上段25 33.3 12.5 4.2 12.5 胸中段18.9 24.5 30.2 3.8 24.5 胸下段1010102050食管癌淋巴转移特点The submucosal lymphatic plexus extend craniocaudally.The lymphatic routes to the regional node originate from the intermuscular area.Lymphatic communication between the submucosa and intermuscular area was rarely apparent histologically.Kuge K. J Thorac Cardiovasc Surg 2003Shanghai Chest Hospital食管癌淋巴转移特点MucosaThe recurrent nerve node often received a major submucosal lymphatic drainage route ascending along the thoracic esophagus.SubmucosaMuscularisMizutani M. Surg Radiol Anat 2006 Shanghai Chest Hospital食管癌淋巴转移特点MucosaFrom the submucosa:to the upper mediastinal and the paracardial nodesSubmucosaMuscularisFrom the muscularis propria:to the periesophageal nodes Shanghai Chest Hospital上海市胸科医院系统性淋巴结清扫结果2001-2010， 247例胸段食管鳞癌性别: M-206, F-41年龄: 31-75岁手术方式: Iovr-Lewis -80, McKeown -167淋巴结清扫: 2F -191, 3F -56上海市胸科医院系统性淋巴结清扫结果pT1