Kodama I, Kofuji K, Yano S, Shinozaki K, Murakami N, Hori H, Takeda J, Shirouzu K
Department of Surgery, Kurume University School of Medicine, Japan.
Int Surg. 1998 Jul-Sep;83(3):205-9.
To suggest improved guidelines for treating lymphatic spread and to understand the results of extended lymphadenectomy. A total of 141 cases of cardia carcinoma admitted to our hospital during 1980 to 1993 were analyzed.
123 of 141 cases underwent resection. The incidence of mediastinal lymph node involvement rose from 8.7% in cases with 1-2 cm invasion to 52.9% in cases with more than 4 cm invasion into the esophagus. The incidence of abdominal lymph node involvement also rose with increasing esophageal invasion. Paraaortic lymph node metastasis was frequently observed in cases of more than 1 cm esophageal invasion. D4 lymphadenectomy (extended lymphadenectomy) revealed better results for the cases with lymph node involvement (P<0.05). There was no difference in the incidence of postoperative complication or in operative death, between the abdominal approach and the thoracoabdominal approach, or between the D4 lymphadenectomy and D2 lymphadenectomy.
Sufficient mediastinal and abdominal lymphadenectomy under a clear wide surgical field achieved through the thoracoabdominal approach appeared to bring better results.
为提出治疗淋巴转移的改进指南并了解扩大淋巴结清扫术的效果。对1980年至1993年期间我院收治的141例贲门癌病例进行了分析。
141例中有123例接受了手术切除。纵隔淋巴结受累发生率从侵犯深度1 - 2厘米的病例中的8.7%上升至侵犯食管深度超过4厘米的病例中的52.9%。腹主动脉旁淋巴结转移在食管侵犯超过1厘米的病例中经常观察到。D4淋巴结清扫术（扩大淋巴结清扫术）对有淋巴结受累的病例显示出更好的效果（P<0.05）。腹部入路与胸腹联合入路之间，以及D4淋巴结清扫术与D2淋巴结清扫术之间，术后并发症发生率和手术死亡率无差异。
通过胸腹联合入路在清晰广阔的手术视野下进行充分的纵隔和腹部淋巴结清扫术似乎能带来更好的效果。
