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目的:探讨胸中段食管癌胸腹二野淋巴结转移规律及其清扫方法,指导临床淋巴结清扫的范围。方法:对95例胸中段食管癌采用右胸及上腹正中两切口术式为基础进行胸腹二野淋巴结清扫,并对淋巴结转移规律进行分析。结果:95例胸中段食管患者淋巴结转移度为20.4%,肿瘤浸润深度和分化程度对淋巴结转移率的影响具有统计学意义。胸中段食管癌既有向上到右颈气管旁、双侧喉返神经链旁、食管旁、癌肿旁、隆突下淋巴结转移,也有向下至贲门旁、胃左动脉旁、胃小弯网膜等处淋巴结转移,呈现双向转移趋势。结论:胸中段食管癌患者淋巴结转移与肿瘤浸润深度及分化程度明显相关。具有胸腹二野淋巴结转移的倾向,右颈气管旁及双侧喉返神经链是淋巴结转移重要区域,右胸及上腹两切口术式更方便胸中段食管癌切除和胸腹二野淋巴结的清扫,并且以此为基础经右胸顶对右颈气管旁及双侧喉返神经链淋巴结清扫也是安全可行的。
Objective: To investigate the rule of thoracic and abdominal second-site lymph node metastasis and the method of clearing it in the mid-thoracic esophagus, and guide the range of clinical lymph node dissection. Methods: A total of 95 cases of middle and upper esophageal cancer were treated by right chest and upper midline incision. The lymph nodes were dissected and the lymph node metastasis was analyzed. Results: The lymph node metastasis rate was 20.4% in 95 cases of middle thoracic esophagus. The depth of tumor infiltration and the degree of differentiation had the significant effect on the lymph node metastasis rate. Mid thoracic esophageal cancer both up to the right side of the tracheal side, next to the bilateral recurrent laryngeal nerve chain, next to the esophagus, next to the cancer, subchondral lymph node metastasis, but also down to the cardia next to the left gastric artery, gastric small curved network Membrane lymph node metastasis, showing a two-way transfer trend. Conclusion: The lymph node metastasis in the middle and upper esophageal cancer patients is closely related to the depth of tumor invasion and the degree of differentiation. With chest and abdomen two wild lymph node metastasis, the right side of the tracheal and bilateral recurrent laryngeal nerve chain is an important area of lymph node metastasis, the right chest and upper abdomen two incisions more convenient esophageal resection of the chest and chest and abdomen, two lymph node dissection , And on the basis of which the right thoracic right pelvis and bilateral recurrent laryngeal nerve neck lymph node dissection is also safe and feasible.