方文涛教授-食管癌淋巴转移规律及手术方式探讨

食管癌淋巴转移规律及手术方式探讨,上海市胸科医院,食管癌淋巴转移特点,1. 淋巴转移先于血路转移解剖基础：黏膜下层丰富淋巴管临床经验：早期淋巴转移、频率随侵润深度升高侵犯至粘膜下层，淋巴结转移率即可达1833侵犯至外膜层以后淋巴结转移率更高达7889,Evidence美国著名临床中心经验， Univ. South California T. R. DeMeester 1994.,Evidence欧洲著名临床中心经验，德国R.Siewert 1995.,Evidence日本全国96家医院调查结果，K.Isono 1991.,上海市胸科医院系统性淋巴结清扫结果,食管癌淋巴转移特点,2. 早期、跳跃式的淋巴转移解剖基础：淋巴管的垂直纵向交通比水平方向的淋巴引流更为丰富临床经验：Evidence远离原发病灶的跳跃淋巴结转移（10%）黏膜下转移（13.5）Kato H. Int J Cancer 1992;50:49-52.,上海市胸科医院系统性淋巴结清扫结果,食管癌淋巴转移特点,黏膜下转移,食管癌淋巴转移特点,3. 淋巴转移途径胸段食管癌的转移高发淋巴结组群为颈胸交界部的喉返神经链淋巴结贲门胃左动脉腹腔动脉链淋巴结以隆突下淋巴结为中心的食管旁淋巴结Akiyama H, et al. Ann Surg 1994;220:364-73.Kato H, et al. J Surg Oncol 1991;48:106-11.Akiyama H. Color Atlas of Surgical Anatomy for Esophageal Cancer. 1992.,上海市胸科医院系统性淋巴结清扫结果,原发肿瘤部位与各区域淋巴结转移率（%）：,Shanghai Chest Hospital,食管癌淋巴转移特点,Kuge K. J Thorac Cardiovasc Surg 2003,The submucosal lymphatic plexus extend craniocaudally.,The lymphatic routes to the regional node originate from the intermuscular area.,Lymphatic communication between the submucosa and intermuscular area was rarely apparent histologically.,Shanghai Chest Hospital,食管癌淋巴转移特点,Submucosa,Muscularis,Mucosa,The recurrent nerve node often received a major submucosal lymphatic drainage route ascending along the thoracic esophagus.,Mizutani M. Surg Radiol Anat 2006,Shanghai Chest Hospital,食管癌淋巴转移特点,Submucosa,Muscularis,Mucosa,From the muscularis propria:to the periesophageal nodes,From the submucosa:to the upper mediastinal and the paracardial nodes,上海市胸科医院系统性淋巴结清扫结果,2001-2010， 247例胸段食管鳞癌性别: M-206, F-41年龄: 31-75岁手术方式: Iovr-Lewis -80, McKeown -167淋巴结清扫: 2F -191, 3F -56,上海市胸科医院系统性淋巴结清扫结果,pT1aN=9,0,27.3,上海市胸科医院系统性淋巴结清扫结果,pT1bN=11,36.4,0,31,上海市胸科医院系统性淋巴结清扫结果,pT2N=42,21.4,11.9,31.9,上海市胸科医院系统性淋巴结清扫结果,pT3N=141,38.3,26.2,36.4,上海市胸科医院系统性淋巴结清扫结果,pT4N=44,43.2,15.9,食管癌根治性切除的标准,“根治性切除”的