食管鳞癌患者三野淋巴结清扫术与二野淋巴结清扫术临床效果的对比研究

摘要

目的：对比分析及研究食管癌患者采用三野淋巴结清扫术与二野淋巴结清扫术治疗后的临床效果。方法回顾性分析我院2009年1月至2013年1月行手术治疗的食管鳞癌患者269例，分为二野清扫组（149例）及三野清扫组（120例）。其中男性患者148例，女性患者121例；胸上段癌58例，胸中段癌127例，胸下段癌84例。术后病理均为鳞癌。结果二野清扫组淋巴结切除组数：5~12组，平均6.24组，转移淋巴结组数：0~4组，平均1.15组。三野清扫组平均切除淋巴结组数8.04组，明显高于二野清扫组6.24组（P=0.015），两组转移淋巴结组数有明显区别（P=0.028）。三野清扫组术后并发症发生率为59.2%（71/120），显著高于二野清扫组46.3%（69/149）（P=0.047），二野淋巴结清扫术组与三野淋巴结清扫术组的四年总生存率分别为48.1%和52.1%，具有统计学差异（P＜0.05）。结论对于食管癌患者，三野淋巴结清扫术能减少肿瘤局部复发，提高术后病理分期的准确性，改善部分患者生存率，但三野淋巴结清扫术手术并发症发生率比二野淋巴结清扫术高。%Objective Comparative study on clinical outcomes of three field lymphadenectomy and two-field lymphadenectomy for esophageal squamous cell carcinoma. Methods 269 patients with esophageal squamous cell carcinoma who were treated surgically in my hospital from January 2009 to January 2013 were retrospectively reviewed. They are divided into 2-FLD group (149 cases) and 3-FLD group (120 cases), including 148 male patients and 121 female patients, The number of the tumor located at upper middle and lower segment was 58, 127, 84 cases respectively. All patients were pathologically diagnosized with squamous cell carcinoma. Results The number of lymph node resected in 2-FLD group were 5-12 groups,with the average of 6.24, the number of metastasis lymph node groups were 0-4 groups, with the average of 1.15 groups. The average of cleaned lymph node groups in 3-FLD group was significantly higher than 2-FLD group(8.04 vs 6.24, P=0.015). The lymph node metastasis rate of 3-FLD group was significantly higher than 2-FLD group. The postoperative complication rate of the 3-FLD group was 59.2%, whicn was significantly higher than the 2-FLD group (46.3%, P=0.047).The four-years survival rate of 3-FLD was significantly higher than the 2-FLD group(52.1%,48.1%). Conclusions Three field lymph node dissection can reduce local recurrence, improve pathological staging accuracy, improve four-years survival rate of some patients with esophageal cancer. However, the surgical complication rate of 3-FLD is higher than the 2-FLD.