The Analysis of Three Fields Lymphadenectomy (3-FL) for 69 Patients with Esophageal Cancer
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摘要: 目的 :探讨食管癌三野清扫(3-FL)淋巴结转移,分析3-FL的重点、难点、适应证、并发症。 方法 :对69例食管癌根治性手术病例进行统计分析比较。 结果 :淋巴结转移度为4.7%,平均每例淋巴结切除数为40个,胸上、中、下三段下颈野淋巴结转移率分别为71.4%、12.8%、12.5%,胸野分别为64.3%、38.5%、50.0%,上腹野分别为7.0%、35.9%、62.5%,双侧喉返神经淋巴链(RLN)占阳性转移率的27.7%,胃左动脉旁淋巴结占阳性转移率的26.9%,锁骨上淋巴结占阳性转移率的12.3%,这三个部位淋巴结占阳性转移率的67.0%,为3-FL的重点,而RLN为3-FL的难点,三段食管癌下颈野淋巴结转移率有显著差异(P<0.005)。胸上、中段作为3-FL的首选适应证,3-FL的并发症与2-FL相比并无明显增多。 结论 :胸上、中段食管癌淋巴结转移清扫是3-FL的首选指征。Abstract: Objective: To evaluate the status of lymphatic metastasis on the 3-FL, the key point, the difficulty, the indication, and the complication of the method of 3-FL. Methods : Statistical analysis and comparison were performed on 69 patients who underwent the radical operations for esophageal cancer. Results : The rate of metastatic lymphatic nodes (MLN) was 4.7% of all resected lymphatic nodes (LN). The average of resected LN was 40 in the patients. The rate of MLN in the lower cervical field was 71.4%, 12.8%, 12.5% originated from upper, middle and lower section of pectoral esophagus respectively, account for 64.3%, 3/.5% and 50.0% in pectoral field respectively, and 7.0%, 35.9% and 62.5% in the upper abdominal field respectively. 27.7% of all positive MLN were along with both of recurrent laryngeal nerve (1LN), 26.9% of all MLN were among the LN along with the left gastric artery and 12.3% among the LN over clavicle. 67.0% of all positive MLN were among three fields above that was considered as the key point to 3-FL. RLN was considered as the difficulty. There are marked difference (!<0.005) of the rate of the MLN to the lower cervical field. Upper and middle pectoral section suffered was considered as the first indication to 3-FL. The complication of 3-FL was not more than that of 2-FL. Conclusion : To clear the MLN originated from the upper and the middle pectoral esophageal cancer is considered as the first preferred indication to take 3-FL.
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