11001140相加食管癌三野淋巴结清扫根治术手术要点课件.ppt

1、癌根治术概念癌根治术概念食管癌手术疗效差原因食管癌手术疗效差原因食管淋巴系统特点食管淋巴系统特点食管癌三野清扫术的目的食管癌三野清扫术的目的不同部位淋巴结转移率不同部位淋巴结转移率肿肿 瘤瘤部部 位位淋巴结转移率淋巴结转移率 (%)(%)(淋巴结转移患者数淋巴结转移患者数/患者总数患者总数)下颈下颈.喉返喉返胸部胸部腹部腹部3-FL应用的主要问题应用的主要问题3-FL应用的主要问题应用的主要问题3-FL并发症并发症v*Ivor-Lweis operation and 2-FL3-FL并发症并发症（肺部）Analysis of pulmonary complications after thre

2、e-field lymph node dissection for esophageal cancer.Ann Thorac Surg.2019 Sep;76(3):903-8.3-FL并发症并发症（喉返神经）3-FL并发症并发症（吻合口瘘）3-FL风险风险（可能的相关因素）3-FL风险风险（年龄的影响）v Fang W,Igaki H,et,al.（Japan）v I组：组：79例例70yr，II组：组：362例例70yr）安全）安全Three-field lymph node dissection for esophageal cancer in elderly patients over

3、 70 years of age.Ann Thorac Surg.2019 Sep;72(3):867-713-FL生存率生存率AuthorYearCases1y3y5yvTachibana,et,al.201914176%58%48%vLerut T,et,al.201919251%41.9%vTabira Yet,al.20199841.3%v安丰山安丰山，等，等201921782.6%59.8%48.8%vOsugi H,et,al.201914970%55%vNishimaki T,et,al.2019156*41.5%v吴昌荣吴昌荣2019338*88.5%63.1%48.4%v*I

4、vor-Lweis operation and 2-FL(LN+)(LN+)(LN+1-4)(LN+1-4)Tabira Y,et,al.Tabira Y,et,al.Kumato Univercity Japan.Kumato Univercity Japan.Thorac Cardiovas Sur Thorac Cardiovas Sur 2019,Feb.2019,Feb.3-FL生存率生存率（影响因子）v Tachibana M,Kinugasa S,et,al.（Japan）v 287例患者，例患者，194例例3-FLv 多因素分析，独立预后因子多因素分析，独立预后因子lymph

5、node metastasis p0.01amount of blood transfusion p0.05length of operation p0.05presence of pulmonary complications p0.05Clinical outcomes of extended esophagectomy with three-field lymph node dissection for esophageal squamous cell carcinoma.Am J Surg.2019 Jan;189(1):98-109.3-FL生存率生存率（T1-2食管癌）Progno

6、stic evaluation of patients with clinical T1 and T2 squamous cell carcinomas of the thoracic esophagus after 3-field lymph node dissection.Surgery.2019 Apr;133(4):368-74.3-FL生存率生存率Three-field lymphadenectomy for carcinoma of the esophagus and gastroesophageal junction in 174 R0 resections:impact on

7、staging,disease-free survival,and outcome:a plea for adaptation of TNM classification in upper-half esophageal carcinoma.Ann Surg.2019 Dec;240(6):962-72;discussion 972-4.3-FL优点优点12343-FL缺点缺点能否真正延能否真正延长生存长生存哪些病例合哪些病例合适三野解剖适三野解剖目前尚无大目前尚无大样本多中心样本多中心前瞻性随机前瞻性随机试验试验三野淋巴结清扫范围三野淋巴结清扫范围三野淋巴结清扫范围三野淋巴结清扫范围三野淋巴结清扫范围三野淋巴结清扫范围v腹腔1贲门右淋巴结2贲门左淋巴结3胃小弯淋巴结4胃大弯淋巴结5幽门淋巴结6幽门下淋巴结7胃左A旁淋巴结8肝总A旁淋巴结9腹腔A旁淋巴结10脾门淋巴结11脾A干淋巴结12肝十二指肠韧带内淋巴13胰后部淋巴结14肠系膜根部淋巴结15结肠中A周围淋巴结16腹主A周围淋巴结三野清扫手术要点三野清扫手术要点三野清扫手术要点三野清扫手术要点三野清扫手术要点三野清扫手术要点 三野清扫手术要点三野清扫手术要点 三野清扫手术要点三野清扫手术要点结束语结束语Fudan University Cancer Hospital