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目的分析食管癌锁骨上淋巴结清扫的临床价值。方法将1997年3月至2004年9月厦门大学附属中山医院收治的无明显锁骨上淋巴结转移食管癌患者197例分为两组,对照组:非锁骨上淋巴结清扫,96例,男62例、女34例,年龄40～69(55.2±3.1)岁;采用区域(胸内淋巴引流区和胃左贲门旁)淋巴结清扫。观察组:锁骨上淋巴结清扫,101例,男68例、女33例,年龄41～68(53.8±4.5)岁;采用三野淋巴结清扫(胸内淋巴引流区、胃左贲门旁及双侧锁骨上淋巴结清扫)。随访两组患者的生存率、淋巴结转移率、吻合口复发率和锁骨上淋巴结远期转移率。结果全组5年生存率为39.59%(78/197),对照组和观察组的5年生存率差异无统计学意义[37.50%(36/96)vs.41.58%(42/101),P>0.05];胸上段食管癌观察组5年生存率显著高于对照组[38.10%(8/21)vs.29.17%(7/24),P<0.05];对照组与观察组胸内淋巴结转移率(14.58%vs.12.87%)、腹腔淋巴结转移率(6.25%vs.7.92%)和吻合口复发率(5.20%vs.5.94%)差异均无统计学意义(P>0.05);锁骨上淋巴结远期转移率观察组显著低于对照组(2.97%vs.8.33%,P<0.05)。结论胸上段食管癌锁骨上淋巴结清扫可以提高其术后的生存率,降低锁骨上淋巴结的远期复发转移率。
Objective To analyze the clinical value of supraclavicular lymph node dissection in esophageal cancer. Methods One hundred and ninety-seven patients with no obvious supraclavicular lymph node metastasis esophageal cancer who were admitted to Zhongshan Hospital Affiliated to Xiamen University from March 1997 to September 2004 were divided into two groups. The control group was non-supraclavicular lymph node dissection, 96 cases, male 62 cases, Female 34 cases, aged 40 to 69 (55.2 ± 3.1) years; the use of regional (thoracic lymphatic drainage area and left gastric cardia) lymph node dissection. In the observation group, 101 patients (68 males and 33 females) aged 41-68 years (53.8 ± 4.5 years) were treated with supraclavicular lymph node dissection. Three lymph nodes dissection (thoracic lymphatic drainage area, gastric left cardia and bilateral supraclavicular lymph nodes Sweeping). Survival rate, lymph node metastasis rate, anastomotic recurrence rate and long-term supraclavicular lymph node metastasis of the two groups were followed up. Results The 5-year overall survival rate was 39.59% (78/197). There was no significant difference in the 5-year survival rates between the control group and the observation group [37.50% (36/96) vs.41.58% (42/101), P > 0.05]. The 5-year survival rate in the upper esophageal cancer group was significantly higher than that in the control group [38.10% (8/21) vs 29.17% (7/24), P <0.05] (14.58% vs.12.87%), lymph node metastasis rate (6.25% vs.7.92%) and anastomotic recurrence rate (5.20% vs.5.94%) had no statistical significance (P> 0.05) The lymph node metastasis rate in the observation group was significantly lower than that in the control group (2.97% vs.8.33%, P <0.05). Conclusions The supraclavicular lymph node dissection of supraclavicular esophagus can improve its postoperative survival rate and reduce the recurrence and metastasis rate of supraclavicular lymph nodes.