目的 探讨微创胸段食管癌右喉返神经旁淋巴结清扫术效果及淋巴结转移的规律和特点。方法回顾性分析2012年1月—2015年6月80例行微创手术治疗胸段食管癌患者的临床资料,分析右喉返神经旁淋巴结转移情况及临床病理特征并进行统计学分析。结果 (1) 本组共清扫右喉返神经旁淋巴结322枚,平均4.0枚(322/80),与以往传统开胸手术相似 80例中26例经病理证实伴右喉返神经旁淋巴结转移,转移率为32.5%(26/80)。(2) 中上段食管癌右喉返神经旁淋巴结转移为21例(42.0%),下段为5例(16.7%),中上段食管癌右喉返神经旁淋巴结转移率明显高于下段食管癌(χ2=4.39,P<0.05);高分化与中低分化食管癌的右喉返神经旁淋巴结转移分别为3例(9.1%)和23例(48.9%),差异显著(χ2=12.27,P<0.01);14例脉管癌栓阳性患者右喉返神经旁淋巴结转移8例(57.1%),显著高于66例无癌栓患者喉返神经旁淋巴结转移17例(25.8%)(χ2=3.94,P<0.05)。26例淋巴结转移患者中,存在淋巴结跳跃性转移。结论 在胸段食管癌患者中,易发生右喉返神经旁淋巴结转移,淋巴结转移频度与肿瘤分化程度及肿瘤位置及脉管癌栓相关,故针对胸段食管癌手术时施行右喉返神经旁淋巴结清扫非常必要。
Objective To study the effect of minimally invasive esophagectomy (MIE) on right recurrent laryngeal nerve lymph nodes,and the characteristics of lymph node metastasis.Methods The clinical data of 80 cases of thoracic esophageal cancer and receiving MIE from January 2012 to June 2015 were analyzed retrospectively.Right recurrent laryngeal nerve lymph node metastasis and clinical pathological features were analyzed.Results (1) In all the patients receiving MIE,the total and average number of right recurrent laryngeal nerve lymph nodes were 322 and 4.0 per case (322/80),respectively,similar to the results by thoracotomy.Twenty-six cases were confirmed by pathology with right recurrent laryngeal nerve lymph node metastasis,and the metastasis rate was 32.5% (26/80).(2) Right recurrent laryngeal nerve lymph node metastasis was found in 21 (42.0%) patients with upper and middle segment esophageal cancer and 5(16.7%) with lower segment esophageal cancer,and the metastasis rate was higher in the patients with upper and middle segment esophageal cancer than in those with lower segment esophageal cancer (χ2=4.39,P<0.05).The metastasis rates in the well differentiated and moderately-poorly differentiated groups were 9.1% and 48.9%,respectively,and the difference was significant (χ2=12.27,P<0.01).The right recurrent laryngeal nerve lymph node metastasis rate was higher in the patients with vascular invasion (57.1%) than those without (25.8%) (χ2=3.94,P<0.05).Lymph node skip metastasis was found in 26 cases with lymph node metastasis.Conclusion In the patients with thoracic esophageal,right recurrent laryngeal nerve lymph nodes metastasis is common and the metastasis rate is closely related with tumor differentiation degree,tumor site,and vascular invasion.It is necessary to perform right recurrent laryngeal nerve lymph node dissection during thoracic esophagectomy.
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