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系统性淋巴结清扫术和选择性淋巴结清扫术治疗早期食管癌的远近期疗效的对比研究

A comparative study of the short-term efficacy and long-term efficacy of systematic lymph node dissection and elective lymph node dissection in patients with early esophageal cancer

摘要:

目的 探讨选择性淋巴结清扫术(ELND)治疗早期食管癌的安全性、有效性和远近期疗效.方法 回顾性收集2007年3月至2013年3月期间在中国科技大学附属第一医院胸外科接受微创食管癌切除术的405例cT1N0M0期食管癌患者的临床资料,根据术中淋巴结清扫方式不同分为系统性淋巴结清扫(SLND)组208例和ELND组197例.采用£检验、x2检验或Wilcoxon秩和检验比较两组患者的临床病理学资料、围手术期资料、淋巴结清扫情况,采用Kaplan-Meier法计算生存率并绘制生存曲线,Log-rank检验比较生存率.结果 两组患者的临床病理学资料无明显差异.在术后微小并发症中,SLND组的肺部感染(8.2%比2.9%,P=0.04)和心律失常(6.2%比2.0%,P=0.03)发生率高于ELND组,在术后重大并发症中,SLND组的肺部感染(6.2%比2.0%,P=0.03)、乳糜胸(5.8%比1.5%,P=0.02)、需再次手术的吻合口或胸腔出血的发生率(2.9%比0.5%,P=0.04)高于ELND组.SLND组和ELND组的1、3、5年生存率无明显差异.分层分析结果显示,Ⅰ期食管癌患者两组的1、3、5年生存率无明显差异,Ⅱa期患者SLND组的1、3、5年生存率优于ELND组(100%、94.5% 、83.2%比100% 、91.3%、72.1%,P=0.047).结论 ELND可较安全有效地治疗Ⅰ期食管癌,远近期疗效良好.

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abstracts:

Objective To investigate the feasibility,safety,short-term efficacy and long-term efficacy of elective lymph node dissection in patients with early esophageal cancer.Methods The study retrospectively evaluated 405 patients with cT1N0M0 esophageal carcinoma who received minimally invasive esophagectomy in the First Affiliated Hospital of University of Science and Technology of China between March 2007 and March 2013.Of those patients,208 patients underwent systematic lymph node dissection (SLND) and 197 patients underwent elective lymph node dissection (ELND).The clinicopathologic factors,operational factors,postoperative complications,lymph node dissection and prognosis of patients were compared by independent sample t test,x2 test,or Mann-Whitney rank test.The 5-year overall survival was calculated by the Kaplan-Meier estimation method using the Log-rank test.Results There was no significant difference in clinicopathological data between the SLND group and the ELND group.The incidence of pulmonary infection (8.2% vs.2.9%,P=0.04) and arrhythmia (6.2% vs.2.0%,P=0.03) of the minor postoperative complications in the SLND group were higher than the ELND group.The incidence of pulmonary infection (6.2% vs.2.0%,P=0.03),Chylothorax (5.8% vs.1.5%,P=0.02),anastomotic or pleural hemorrhage requiring reoperation (2.9% vs.0.5%,P=0.04) of major postoperative complications in the SLND group were higher than the ELND group,the difference was statistically significant.In the perioperative data of two groups,the incidence of total postoperative complications,total pulmonary complications,operation time,intraoperative blood loss,postoperative hospitalization,postoperative thoracic drainage duration and postoperative thoracic drainage fluid volume of the SLND group were higher than the ELND group,the difference was statistically significant.The mean numbers and stations of dissected lymph node in the SLND were 30.2±4.2 and 12.1±2.7,the mean numbers and stations of dissected lymph node in the ELND were 25.7±3.8 and 8.4,±3.6.The survival rates of 1,3,5 years of all patients were 100%,95.9% and 82.5%,respectively.The median survival time was 87.4 months.Further analysis showed that the 1,3 and 5 years survival rate of patients with stage Ⅰ esophageal cancer was 100%,97.1% and 88.9%,respectively.The median survival time was 89.3 months.The 1,3 and 5 years survival rate of patients with stage Ⅱ a esophageal cancer was 100%,93.2% and 76.8%,respectively.The median survival time was 77.2 months.There was no significant difference in survival rate between the SLND group and the ELND group in 1,3 and 5 years.When taking a further analysis of stage Ⅰ esophageal cancer,the survival rates between 188 patients in the SLND group and 180 patients in the ELND group were no significant difference.When focus on the stage Ⅱ a esophageal cancer,the 1,3 and 5 years survival rate were higher in the SLND group than that in the ELND group (100%,94.5%,83.2% vs.100%,91.3%,72.1%,P=0.047),the difference was statistically significant.Conclusion ELND can be safely and effectively performed for early esophageal cancer with favorable short-term efficacy and long-term efficacy.

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作者: 吴汉然 [1] 柳常青 [1] 郭明发 [1] 梅新宇 [1] 田界勇 [1] 徐美青 [1]
第一作者: 吴汉然
作者单位: 中国科技大学附属第一医院胸外科,合肥,230001 [1]
期刊: 《中华外科杂志》2018年56卷9期 706-711页 MEDLINEISTICPKUCSCD
栏目名称: 论著
DOI: 10.3760/cma.j.issn.0529-5815.2018.09.012
发布时间: 2018-09-25
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