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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。
Objective: To investigate the significance of 3-FL lymph node metastasis in esophageal cancer patients with 3-FL dissection and analyze the key points, difficulties, indications and complications of 3-FL. Methods: 69 cases of esophageal cancer radical surgery cases were statistically analyzed and compared. Results: The lymph node metastasis rate was 4.7%, the average number of lymphadenectomy per case was 40, and the rates of lower cervical and lymphatic metastasis in the upper, middle and lower three segments were 71.4%, 12.8% and 12.5% respectively, and chest field were 64.3% , 38.5%, 50.0% in the upper abdomen, 7.0% in the upper abdomen, 35.9% in the upper abdomen, and 62.5% in the upper rectum. The positive rate of RLN was 27.7% %, The supraclavicular lymph nodes accounted for 12.3% of positive metastasis, the three parts of lymph nodes accounted for 67.0% of the positive metastasis rate, the focus of 3-FL, and RLN for the 3-FL of the difficulty of esophageal cancer under the three cervical lymph nodes There was a significant difference in metastasis rates (P <0.005). As the first indication of 3-FL in the upper and middle breasts, the complication of 3-FL was not significantly higher than that of 2-FL. Conclusion: Lymph node metastasis of the upper and middle esophageal cancer is the first indication of 3-FL.