摘要目的 探讨胸段食管癌淋巴结转移的规律和特点,从而为其手术入路和淋巴结清扫范围提供参考.方法 回顾性分析2009年1月至2012年12月间中南大学湘雅医学院附属肿瘤医院胸外科收治的72例胸段食管癌患者的临床资料,所有病例均行右胸入路手术.记录各组淋巴结的清扫及转移情况,并分析淋巴结转移的影响因素.结果 72例患者中,有48例出现淋巴结转移,淋巴结转移率为66.7％；清扫淋巴结总数为1495枚,转移181枚,淋巴结转移度为12.1％,平均每例清扫淋巴结20.8枚.在各组淋巴结中,右喉返神经旁(1R组)淋巴结转移率最高,达30.6％(22/72).左喉返神经旁淋巴结(2L组、4L组和5组)转移率为12.5％(9/72).淋巴结转移率与肿瘤大小和浸润深度有关(均P＜0.05),而与病变部位和分化程度无关(P＞0.05).结论 胸段食管癌淋巴结转移以右喉返神经旁淋巴结转移为主,故其手术最佳入路应是右胸入路,淋巴结清扫则应以右、左喉返神经旁淋巴结为重点的系统纵隔、腹野淋巴结清扫.

abstractsObjective To explore the characteristics of lymph node metastasis in thoracic esophageal cancer in order to provide evidence for the extent of lymph node dissection and the operation access.Methods A retrospective study was performed on the specimens of 72 patients who underwent radical operation of right transthoracic approach and the features of lymph node metastasis were explored.Results Lymph node metastases were found in 48 of 72 patients (66.7％).In 1495 lymph nodes dissected,metastases was indentified in 181 lymph nodes (12.1％).The rate of lymph node metastasis in the right and left recurrent laryngeal nerve was 30.6％ and 12.5％ respectively.Lymph node metastasis was associated with tumor size and tumor invasion depth (both P ＜ 0.05),while tumor location and differentiation of tumor cells were not significant(both P ＞ 0.05).Conclusions The lymph node metastasis in thoracic esophageal carcinoma can be easily found in the right recurrent laryngeal nerve.The best surgical approach of thoracic esophageal carcinoma is the right transthoracic approach.