目的 探讨食管癌根治术淋巴结清扫的合适范围.方法 2010年1月至2013年12月收治的160例食管癌患者按淋巴结清扫方式不同分为三野清扫组(86例,行颈、胸、腹三野淋巴结清扫)和二野清扫组(74例,行胸、腹二野淋巴结清扫),比较两组患者术后淋巴结转移和并发症情况以及近期生存率.结果 三野清扫组患者淋巴结清扫个数与二野清扫组淋巴结清扫个数分别为28.60±3.30和14.54 ±5.59(P ＜0.05).术后并发症发生率分别为22.09％和14.86％,组间比较差异均无统计学意义(P＞0.05).三野清扫组及二野清扫组患者术后0.5年生存率分别为93.02％和83.78％,三野清扫组显著高于二野清扫组(P＜0.05).结论 三野淋巴结清扫术与二野淋巴结清扫术相比,能更彻底清扫颈部及上纵隔淋巴结,降低局部复发率,提高患者术后生存率,建议对排除远处转移的食管癌患者常规行三野淋巴结清扫术.%Objective To compare short-term clinical effect according to the extent of lymphadenectomy.To identify the rational lymph node dissection in patients with esophageal squamous cell carcinoma(ESCC).Methods Between January 2010 and December 2013,160 patients with ESCC received video-assisted laparothoracoscopy esophagectomy plus three-field lymphadenectomy(3FL) (86 cases)or two-field lymphadenectomy(2FL) (74 cases).Retrospectively analyzed the lymph node metastasis, postoperative complications and short-term survival rates between 3FL and 2FL.Results There was significantly differences in the number of lymph node between 3 FL(28.60 ± 3.30) and 2 FL(14.54 ± 5.59) (P ＜ 0.05) , but no significantly differences in postoperative complications between 3FL(22.09％) and 2FL(14.86％) (P ＞ 0.05).There was significantly differences in half-year survival rates between 3FL(93.02％) and 2FL(83.78％) (P ＜ 0.05).Conclusion Three field lymph oode dissection can reduce local recurrence, improve survival rate of some patients with ESCC.We suggest that esophagectomy plus three-field lymphadenectomy should be conventional.
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