胡青+周浩+林永德+杨洋+韩鑫+周叶枫+周晟劼

[摘要] 目的 分析胸段食管癌喉返神经旁淋巴结清扫的临床意义。方法 便利选取该院2015年9月—2017年3月期间胸外科收治的100例食管中下段癌患者为例，所有入组患者均行胸腹两切口食管癌根治术（Ivor-Lewis术）治疗，术中加喉返神经旁淋巴结清扫。观察患者出现喉返神经旁淋巴结转移的情况，分析其并发症发生状况。 结果 100例患者行手术发现29例出现喉返神经淋巴结转移情况，右喉返神经19例，左喉返神经10例，共计清扫392枚淋巴结，其中62枚淋巴结有转移，转移率为29.00%，转移度为15.82%。9例术中发生声嘶，占9.00%，6例在术后3个月恢复正常，该次研究无患者死亡。结论 在胸段食管癌患者中喉返神经旁淋巴结转移发生的几率较高，行喉返神经旁淋巴结清扫可提高分期诊断准确性，并对其进行有效清扫，减少术后复发。

[关键词] 食管癌；喉返神经；淋巴结清扫；临床意义

[中图分类号] R5 [文献标识码] A [文章编号] 1674-0742（2017）11（b）-0093-03

[Abstract] Objective This paper tries to analyze the clinical significance of laryngeal esophagectomy lymph node dissection. Methods A total of 100 patients with esophageal cancer enrolled in this hospital from September 2015 to March 2017 were convenient seleced. All patients underwent thoracic surgery for esophageal cancer and were treated with recurrent laryngeal lymph nodes. The occurrence of recurrent laryngeal nerve lymph node metastasis and the characteristics of the transfer， the incidence of complications were compared and observed. Results Of the 100 patients， 29 cases had recurrent laryngeal nerve lymph node metastasis. 19 cases of right recurrent laryngeal nerve and 10 cases of left recurrent laryngeal nerve. A total of 392 lymph nodes were cleared， of which 62 lymph nodes were transferred and the metastasis rate was 29.00%， the transfer rate of 15.82%. 9 cases of intraoperative scissors， accounting for 9.00%， 6 cases in 3 months after surgery returned to normal， no patients died. Conclusion In patients with thoracic esophageal cancer， the incidence of recurrent laryngeal lymph node metastasis is higher， and laryngeal recurrent lymph node dissection can improve the accuracy of staging and effectively clean and reduce postoperative recurrence.

[Key words] Esophageal cancer； Recurrent laryngeal nerve； Lymph node dissection； Clinical significance

作為临床上常见的消化道肿瘤，食管癌的发病率和死亡率都非常高，其典型症状就是进行性吞咽困难，一般通过外科根治手术进行治疗。近年来，整块肿瘤切除及区域淋巴结清扫在治疗食管癌上取得了较大的成效，区域淋巴结彻底廓清是食道癌根治术的重要步骤，其中喉返神经旁淋巴结是最主要转移部位，对该部位进行清扫后可减少术后复发，有助于预后[1]。该次研究以该院于2015年9月—2017年3月期间收治的100例食管中下段癌行Ivor-Lewis食管癌根治术的患者为例，探讨胸段食管癌喉返神经旁淋巴结清扫的临床意义，现报道如下。……