现代二野清扫术在胸中段食管癌手术中应用

目的：探讨现代二野清扫术在胸中段食管癌手术中应用的可行性及必要性。方法：将2010年1月至2011年1月本院30例可手术的胸中段食管癌患者完全随机分成两组（n=15）：A组（研究组）：经右胸上腹左颈三切口食管次全切除左颈吻合＋现代二野清扫术；B组（对照组）：经左胸食管次全切除左颈吻合＋标准二野清扫术。比较两组的手术时间、术中出血量、术后并发症和手术切除率。结果：手术时间、术中出血量、术后并发症两组差异无统计学意义，两组手术切除率均为100％。两组在胸部平均淋巴结清扫个数、喉返神经链平均淋巴结清扫个数和喉返神经链淋巴结转移度差异有统计学意义（P〈0．05）。结论：胸中段食管癌经右胸三切口行现代二野清扫操作安全可行，可更彻底清扫胸中段食管区域淋巴结，术后病理分期更准确。

The use of modern two-field lymph node dissection in mid-thoracic esophageal cancers

Objective：To explore the need and feasibility for modem two-field lymph node dissection in mid-thoracic esophageal cancers. Method： Between January 2010 and January 2011,30 patients with operable mid-thoracic esophageal cancer registered to our hospital were randomized into two groups （n = 15 each） ： the study group（ Group A） to receive subtotal esophagectomy via the right chest, upper abdominal and left neck（ C3 level） incisions plus anastomosis via left neck incision plus modern two-field lymph node dissection, and the control group （ Group B） to receive subtotal esophagectomy via the left chest incision plus anastomosis via left neck incision plus standard two-field lymph node dissection. The operation time, intraoperative blood loss, postoperative complications and rate of successful resection were compared between the two groups. Results：The both groups did not differ significantly in operation time, intraoperative blood loss and postoperative complications. The rate of successful resection was 100% in the two groups. Statistical differences between the two groups were found in mean number of dissected lymph nodes in the chest and along the recurrent laryngeal nerve,as well as in number of invaded lymph nodes along the recurrent laryngeal nerve （ all P 〈 0. 05 ）. Conclusion：Modern two - field lymph node dissection via three incisions （including the right chest） appears feasible and safe, and is helpful for more radical dissection of lymph nodes in the region of thoracic esophagus, and more accurate pathological staging after operation.