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目的 了解胸段食管鳞癌淋巴结转移特点及对预后的影响 ,探讨合理的淋巴结清扫范围。方法 对 2 43例单纯手术切除胸段食管鳞癌患者的临床资料进行回顾性分析。结果 淋巴结转移率 45 .3% ,转移度 10 .5 % ,表现为沿食管周的上下“双向性”转移。影响淋巴结转移的因素为肿瘤浸润深度和肿瘤分化 ,肿瘤长度则影响不大。有淋巴结转移的患者 5年生存率为 16 .4% ,明显低于无淋巴结转移患者的 5 1.9% (P <0 .0 1)。淋巴结转移个数对患者预后影响不大。结论 淋巴结转移是影响食管癌切除患者预后的主要因素。胸上、中、下段食管癌表现出不同程度的上、下行转移 ,因此应采取不同的淋巴结清扫范围。对胸下段癌行胸、腹二野清扫即可 ,对病变较早的胸中、上段癌则应行颈、胸、腹三野清扫
Objective To understand the characteristics of lymph node metastasis in thoracic esophageal squamous cell carcinoma and its influence on prognosis, and to explore a reasonable range of lymph node dissection. Methods The clinical data of 438 patients who underwent thoracic esophageal squamous cell carcinoma were retrospectively analyzed. Results The lymph node metastasis rate was 45.3%, and the degree of metastasis was 10.5%. It showed an up-and-down “bidirectional” metastasis along the esophageal circumference. The factors affecting lymph node metastasis are the depth of tumor invasion and tumor differentiation. The length of the tumor has little effect. The 5-year survival rate of patients with lymph node metastasis was 16.4%, which was significantly lower than that of patients without lymph node metastasis (5.1%) (P < 0.01). The number of lymph node metastases has little effect on the prognosis of patients. Conclusion Lymph node metastasis is the main factor affecting the prognosis of patients with esophageal cancer resection. The upper, middle, and lower thoracic esophageal cancers show different degrees of up- and down-stream metastases, so different lymph node dissections should be taken. The chest and lower abdomen can be cleaned by the chest and abdomen. For the early stage of upper and middle chest cancer, the neck, chest and abdomen should be cleaned.