Objective To investigate lymph node metastasis on the middle and lower segment of lⅡ and Ⅲ stage of esophageal squamous cell carcinomas,understand the factors influencing the lymph node metastasis,and provide the basis for the key areas of lymph node cleaning.Methods A retrospective study was made on the specimens of 186 patients who were middle and lower segment of Ⅱ and Ⅲ stage of esophageal squamous cell carcinomas,who had underwent radical operation through left thoracic,thoraco abdominal two field lymph node cleaning.All the cases were patients from April 2010 to December 2013 at the Inner Mongolia Medical University Clinical Medical College of Chifeng.Results A percentage (67.9％) of patients (126/186) was found with lymph node metastasis.A total of 4259 lymph node was dissected,with an averaged cleaning of (22.9 ± 8.1) lymph nodes for each case.A total of 622 lymph nodes (14.6％ =622/4 259) existed metastasis.The rate of mediastinum metastasis for middle and lower segment of esophageal cancer was 56.1％ and 16.5％,respectively.The rate of metastasis to the lower mediastinal lymph nodes was 34.6％ and 54.4％,respectively.The rate of metastasis to the celiac lymph nodes was 23.4％ and 46.8％,respectively.A significant difference was found in the metastasis locations of middle and lower segment of esophageal carcinomas (P ＜ 0.05).The top three locations of lymph node metastasis in the middle segment of esophageal squamous cell carcinomas were the lymph nodes of left artery paraesophageal,carina,and gastric bypass.The top three locations of lymph node metastasis in the lower segment of esophageal squamous cell carcinomas were paraesophageal,cardia,and gastric lymph nodes.The depths of tumor invasion,differentiation,intravascular cancer embolus were statistically significant effect on lymph node metastasis rate (P ＜ 0.05).Tumor location,and lesion length had no significant effect on the lymph node metastasis rate (P ＞ 0.05).Conclusions The lower segment of Ⅱ,Ⅲ stage esophageal squamous cell carcinoma with lymph node metastasis occurs in the lower mediastinal and abdominal lymph nodes.The middle segment Ⅱ,Ⅲ stage esophageal squamous cell carcinoma with lymph node metastasis occurs in the thoracic and abdominal lymph nodes with Jump transfer characteristics.The lymph node cleaning of the mid-dle segment includes the left artery near the stomach,paraesophageal,and carina lymph node.The lymph node cleaning of the lower segment includes paraesophageal,cardia,and gastric lymph nodes.The metastasis rate of vascular tumor thrombus is related to the depth of tumor invasion and differentiation degree.

Objective To investigate the lymph node metastasis on the middle and lower segment of esopha-geal squamous cell carcinoma ,understand the factors influencing lymph node metastasis ,to further provide the theory evidence for the lymph node dissection on the middle and lower segment of esophageal squamous cell carcinoma patients of Mongolian nationality .Methods A retrospective study was made in 108 Mongolian patients suffered from the middle and lower segment of esophageal squamous cell carcinoma who accepted radical resection of esophageal carcinoma by three incisions of right chest or combined with right thoracic laparoscopic in three incisions .Results A total of 4914 lymph nodes were dissected,with an averaged clean of (45.5 ±6.0)lymph nodes for each case.80.6％of patients(87/108) were found lymph node metastasis .A total of 624 lymph nodes (624/4914,12.7％) existed metastasis.The rates of superior, middle and inferior mediastimum metastasis for middle segment of esophageal squamous cell carcinoma patients of Mongolian nationality were 20.6％,57.4％ and 39.7％,respectively,while the rates of superior ,middle and inferior mediastimum metastasis for lower segment of esophageal squamous cell carcinoma patients of Mongolian nationality were 17.5％,47.5％and 47.5％,respectively.There was no statistically significant difference between the two groups (P >0.05).The rate of lymph node peritoneal metastasis of lower segment of esophageal squamous cell carcinoma patients of Mongolian nationality was higher than that of middle segment of esophageal squamous cell carcinoma patients of Mongolian nationality (62.5％vs.16.2％,χ2 =24.320,P<0.05). The top three lymph node metastasis sites of middle segment of esophageal squamous cell carcinoma were para esophagus ,carina and recurrent laryngeal nerve .The top three lymph node metastasis sites of lower segment of esophageal squamous cell carcinoma were para esophagus ,cardia side and carina .The influence of the depth of tumor invasion,differentiation degree , intravascular cancer embolus and perineural invasion to the rate of lymph node metastasis was statistically significant(χ2 =21.630,7.568,21.066,4.692,all P<0.05).There were no statistically significant differences of the location ,the tumor length or whether had heavy drinking or not to the rate of lymph node metastasis( all P >0.05).Conclusion The rate of lymph node metastasis on both the middle and lower segment of esophageal squamous cell carcinoma is high .The mediastinum lymph nodes needs to be emphatically cleaned . Abdominal lymph nodes cleaning of lower segment of esophageal squamous cell carcinoma can 't be overlooked .Among the Mongolian patients ,the cleaning key of lymph node on the middle segment of esophageal squamous cell carcinoma are para esophagus ,carina and recurrent laryngeal nerve ,while the cleaning key of lymph node on the middle segment of esophageal squamous cell carcinoma are para esophagus ,cardia side and carina.The deeper the tumor infiltration is,the lower the differentiation degree is , with cancer embolus in vessels , nerve invasion , the higher rate of the lymphatic metastasis.

Objective To prospectively study the clinical diversity of the middle and lower segment of stage of esophageal cancer patients who accepted the thoracoscopic combined with laparoscopic esophagectomy ( TLE) between Mongolian and Han nationalities in Inner Mongolia , to further clarity the feasibility of TLE.Methods 92 consecutive cases of middle and lower segment of stage of esophageal cancer patients of Mongolian and Han were selected,and the patients accepted the TLE ,including 41 cases of Mongolian and 51 cases of Han.The postoperative pain was evaluated with the visual analog scale (VAS) at 1-14d after operation,and the postoperative complication , the hospitalization of postoperation and the postoperative pathological situation were compared .Results Compared with the Han patients,the postoperative pain of Mongolian significantly reduced ,duration of postoperative of pain significantly shorter in the 1-5 d after surgery(P <0.05).Mongolian patients turned to mild pain in the second day of the postoperative period,and Han turned to mild pain in the fourth day after surgery .The postoperative pain in the 6-14 d after surgery of the Mongolian was not significantly different from Han (P >0.05).The Mongolian had lower incidence rate of postoperative complication compared with Han (9.8% vs.27.5%,χ2 =4.522,P <0.05).For example,the incidence rates of respiratory complications in Mongolian patients ,such as pulmonary infection,atelectasis and the occurrence of pleural effusion that need to be treated were significantly lower than those in Han (7.3% vs. 23.5%,2.4% vs.15.7%,4.9% vs.19.6%,P <0.05).There was no statistically significant difference in the incidence of other complications(P >0.05).The postoperative hospitalization of Mongolian was significantly shorter than that of Han[(11.9 ±1.2) d vs.(15.5 ±1.0) d,t =-15.811,P <0.05].No significant difference in the total number of cases of lymph node dissection ,the abdominal lymph node dissection and the chest lymph node dissection . The number of the regional lymph nodes metastasis of Mongolian was higher than that of Han [(3.9 ±0.7) vs. (1.8 ±0.7),t =13.460,P <0.05],most of which were poorly differentiated (6 /25/10 vs 20 /20 /11,χ2 =7.139, P <0.05).Meanwhile,the incidence rates of cancer embolus in the vasculature and nerve invasion of Mongolian were higher than those of Han(75.6% vs.47.1%,70.7% vs.17.6%,χ2 =7.706,26.418,all P <0.05).Conclusion The Mongolian were more easily tolerant to the TLE,which has the advantages of reducing pain ,trauma,rapid recovery, satisfactory curative effect and the lesser postoperative complications .The degree of the malignancy of esophageal cancer of Mongolian was higher than Han .Mongolian who suffered from esophageal cancer needed earlier discovery , earlier treatment and further research of the causes of difference .

Objective:To investigate the clinical efficacy of double tract reconstruction of proximal gastric resection and Roux-en-Y total gastrectomy in the treatment of adenocarcinoma of the esophagogastric junction, in order to provide reference for clinical selection.Methods:From June 2016 to June 2018, patients with adenocarcinoma of the esophagogastric junction in Chifeng City hospital were prospectively selected and randomly divided into proximal gastrectomy double channel anastomosis group (PG group) and total gastrectomy Roux-en-Y anastomosis group (TG group). The perioperative indexes, clinical pathology, early (≤ 30 days) and late (> 30 days) complications of the two groups were compared, and the nutritional status [body mass index (BMI), prealbumin, albumin, total protein], and anemia degree [hemoglobin (Hb), red blood cell count (RBC)] of the two groups at 3 months, 6 months and 12 months after operation were compared.Results:A total of 83 patients with adenocarcinoma of the esophagogastric junction were admitted, including 62 patients who were eligible for surgery, 31 cases in each group, 1 case in each group was lost to follow-up, and 30 cases in each group. There were no tumor recurrence or death in two groups. There were no statistically significant differences in age, gender, tumor size, tumor stage, preoperative complications, preoperative nutritional status and anemia between the two groups ( P>0.05). The time of first exhaust, time of starting fluid feeding and postoperative hospitalization in PG group was significantly earlier than that in TG group [(3.0±0.7)days vs (4.2±0.7)days, (7.9±0.9)days vs (9.0±0.9)days, (13.3±1.1)days vs (14.6±0.9)days, P<0.05], while the operation time was slightly longer [(252.0±36.9)min vs (225.8±31.1)min, P<0.05]. There was no significant difference in intraoperative blood loss and number of lymph node dissection between PG group and TG group [(241.7±81.0)ml vs (245.8±71.9)ml, (40.5±12.2)nodes vs (43.2±10.3)nodes, P>0.05]. There was no statistically significant difference in the occurrence of early and late postoperative complications ( P>0.05). The incidence of reflux esophagitis in PG group was less than that in TG group ( P<0.05). The nutritional status of PG group was significantly better than TG group in 3 months, 6 months and 12 months after the operation ( P<0.05). The Hb and RBC decreased in both groups at 3 and 6 months after operation, and the Hb and RBC in PG group were higher than those in TG group. There was no anemia in PG group and TG group 12 months after operation. Conclusions:Double tract reconstruction of proximal gastric resection is effective in the treatment of adenocarcinoma of the esophagogastric junction. It is worthy of further clinical promotion.

Objective:To investigate early postoperative psychological pain in patients with esophageal cancer and analyze its influential factors, providing evidence for developing accurate psychological management plan during the perioperative period of esophageal cancer.Methods:A cross-sectional study was conducted on the demographic data, disease data, and psychological pain screening management tool (Distress Management Screening Measurement of patients with esophageal cancer who received treatment in Chifeng Municipal Hospital between January 2019 and January 2021 with a self-designed general data questionnaire.Results:The average score of the distress thermometer was 4.5 ± 0.8 points among the 106 patients with esophageal cancer in the early postoperative stage. DT score was < 4 points in 40 patients (37.7%) and it was ≥ 4 points in 66 patients (62.3%). Univariate analysis revealed that in the general data questionnaire, education level, hospital expense, smoking history, and operation methods were the influential factors of early postoperative esophageal cancer ( χ2 = 7.87, 9.56, 12.65, 7.03, all P < 0.05). In the list of psychological pain-related problems, fatigue, depression, pain, sleep, breathing, eating, and child care were the influential factors of early postoperative physiological pain in patients with esophageal cancer ( χ2 = 48.18, 64.19, 42.17, 27.14, 36.13, 35.01, 8.01, all P < 0.05). Multivariate regression analysis showed that in the general data questionnaire, education level, hospital expense, smoking history, and operation methods were the influential factors of early postoperative esophageal cancer ( χ2 = 14.71, 8.31, 13.56, 6.47, all P < 0.05). In the list of psychological pain-related problems, fatigue, depression, pain, breathing, and eating were the influential factors of early postoperative physiological pain in patients with esophageal cancer ( χ2 = 5.45, 3.91, 4.89, 3.96, 4.00, all P < 0.05). Conclusion:The incidence of early postoperative psychological pain is high in patients with esophageal cancer. The main influential factor of psychological factors are physical problems, while the influential factors emotional problems, education level, hospital expense, smoking history, and operation methods cannot be ignored.