Tachibana Mitsuo, Kinugasa Shoichi, Hirahara Noriyuki, Yoshimura Hiroshi
Digestive Surgery, Department of Surgery, Faculty of Medicine, Shimane University, Izumo, Shimane, Japan.
Eur J Cardiothorac Surg. 2008 Aug;34(2):427-31. doi: 10.1016/j.ejcts.2008.04.022. Epub 2008 May 23.
The lymphatic channels of the esophagus run vertically along the axis of the esophagus and some of them drain into the cervical lymph glands upwards and into the abdominal glands downwards, and the pattern of lymph node metastasis of esophageal carcinoma is widespread. In various classifications of pattern of lymphatic spread, four classifications were proposed; location, number, ratio, and size. No definite survival advantage of aggressive lymph node dissection during esophagectomy has been proved compared with less dissection. Stage migration, micrometastasis, and sentinel lymph node concept all make it possible to individualize surgical management of esophageal carcinoma as a part of various multimodal treatments. Early diagnosis, standardization of surgery including routine lymph node dissection, and perioperative management of patients have all led to better survival rates of esophageal carcinoma.
食管的淋巴管道沿食管轴线垂直走行，其中一些向上引流至颈部淋巴结，向下引流至腹部淋巴结，食管癌的淋巴结转移模式较为广泛。在各种淋巴扩散模式分类中，提出了四种分类方式：位置、数量、比例和大小。与较少的淋巴结清扫相比，食管癌切除术中积极的淋巴结清扫并未被证明具有明确的生存优势。分期迁移、微转移和前哨淋巴结概念都使得将食管癌的手术管理个体化成为各种多模式治疗的一部分成为可能。早期诊断、包括常规淋巴结清扫在内的手术标准化以及患者的围手术期管理都提高了食管癌的生存率。
