胸段食管鳞癌左开胸二野清扫术后复发规律的探讨

摘要

Objective:To analyse the features of recurrent of thoracic esophageal carcinoma after radical left thora-cotomy with two - field lymph node dissection. Methods:We reviewed the data of 111 recurrence cases with thoracic esophageal carcinoma after radical thoracotomy. Results:In 111 cases,the median recurrence time was 16. 0 months, 82. 9% happened within 3 years after operation. The major clinical manifestation of recurrence was hoarseness (36. 0% ). Recurrence regions:The single local regional recurrence was 76. 6% ,the single distant metastasis was 6. 3% ,and the concurrently recurrence of regional and distant metastasis was 17. 1%(P = 0. 0000). In local regional recurrence:The recurrent rates of mediastinal lymph node,the lower neck and supraclavicular lymph node,abdominal lymph node,anastomosis and tumor bed were 60. 4% ,48. 6% ,10. 8% ,15. 3% ,1. 8% ,respectively. In 26 cases with distant metastasis:The lung metastasis rate was 50. 0% . There was no significant difference of recurrent regions among the 3 primary esophageal carcinoma. The lymph node recurrence rate of the upper mediastinal,medium mediastinum and lower mediastinum was 55. 9% ,19. 8% ,1. 8%(P = 0. 000),respectively. Among mediastinum lymph node me-tastasis,1st,2nd,4th,7th region lymph node metastasis was 42. 3% ,34. 2% ,22. 5% and 18. 0% ,respectively. The logistic analysis showed that there was a significant correlation between T staging and mediastinal lymph node recur-rence. Conclusion:Most of recurrence developed within 3 years after operation. The common clinical manifestation of recurrence was hoarseness and the common recurrence was local region. The common local regional recurrence was the lower neck and supraclavicular lymph nodes and mediastinal 1st and 2nd lymph nodes region. There was no significant difference of recurrent regions among the 3 primary esophageal cancer sites.%目的：分析胸段食管鳞癌根治性左侧开胸二野清扫术后复发的规律，为术后辅助性治疗提供依据。方法：收集1998年6月-2012年12月收治的111例胸段食管鳞癌术后复发的患者，分析其复发情况。结果：111例患者中位复发时间为16.0个月，82.9%患者在术后3年内复发，复发时临床表现以声音嘶哑为最常见（36.0%）。复发类型：单纯局部区域复发76.6%，单纯远处转移6.3%，区域复发合并远处转移17.1%（P =0.000）。局部复发中纵隔淋巴结转移60.4%，下颈锁骨区淋巴结转移48.6%，腹腔淋巴结转移10.8%，吻合口复发15.3%，瘤床区复发1.8%。远处转移26例中，肺转移占50.0%。不同原发部位食管癌之间复发区域的差异无统计学意义（P ＞0.05）。纵隔淋巴结转移中，上纵隔复发率55.9%，中纵隔19.8%，下纵隔淋巴结转移1.8%（P =0.000），在纵隔淋巴结复发中，1、2区淋巴结复发率分别为42.3%和34.2%，4区22.5%，7区18.0%。采用 logistic 分析复发部位与临床资料相关性，结果显示纵隔淋巴结转移与 T 分期有关。结论：胸段食管鳞癌根治性左开胸二野清扫术后复发多在术后3年内发生，以声音嘶哑常见，淋巴结复发为主要复发类型，其中下颈锁骨区及上纵隔1、2区淋巴结复发多见，不同原发部位食管癌之间复发区域无差异。