中上段食管癌两种三切口术式的临床研究

A Clinical Study of Two Approaches of“"Three-incisions” for Esophagectomy and Digestive Tract Reconstruction in the Treatment of Middle-upper Esophageal Carcinoma

[目的]探讨两种三切口术式在中上段食管癌切除消化道重建术中的临床应用价值。[方法]总结2001年10月至2003年9月行三切口中上段食管癌切除共93例。其中更换体位的三切口经胸骨后隧道的消化道重建术48例(A组),不更换体位的三切口经食管床消化道重建术45例(B组),对其临床资料进行对照分析。随访时间均在6个月以上。随访率90.32%(84/93)。[结果]全组病例无手术死亡,手术时间:A组3.5h～4.5h(平均4h)。B组3.0h～4.2h(平均3.5h)。术中出血量:A组平均420ml,B组平均380ml。淋巴结清除:A组平均22个,B组平均14个。关胸时间:A组平均1.8h,B组平均3.2h。心肺并发症:A组5/48(10.4%),B组13/45(28.9%)。吻合口瘘:A组4例,B组5例。胸胃症状:A组无,B组13例。反流性食管炎:A组8例,B组7例。[结论]更换体位的三切口中上段食管癌切除经胸骨后隧道消化道重建术是有效可行的手术方法,尤其是关胸时间、心肺并发症、淋巴结清除及胸腔胃不适症状等方面均明显优于不更换体位的中上段食管癌三切口切除经食管床消化道重建术。

Purpose]To investigate the clinical application value of two approaches of three-incisions for esophagectomy and digestive tract reconstruction in the treatment of middle-upper esophageal carcinoma.[Methods]Ninety-three cases with middle-upper esophageal carcinoma underwent three-incisions esophagectomy and digestive tract reconstruction from Oct.2001 to Sep.2003. These cases were randomized into two groups.(1)Group A:48 cases,the patient's position was changed during operation and digestive tract reconstruction through post-sternum canal was taken.(2)Group B:45 cases, no position changes was taken during operation and digestive tract reconstruction through esophageal bed was taken. The clinical data of the two groups were compared and analysed. [Results] The operating time ranged from 3.5 to 4.5 hours(average 4 hours) in group A and 3.0 to 4.2 hours(average 3.5 hours)in group B.Average hemorrhage during operation was 420ml in group A and 380ml in group B.Lymph node dissection:average 22 in group A and 14 in group B.The average time of closing thoracic cavity was 1.8 hours in group A and 3.2 hours in group B.Cardiopulmonary complication:5/48(10.4%) in group A and 13/45(28.9%) in group B.Anastomotic leakage:4 cases in group A and 5 cases in group B. Symptom of thoracic stomach:none in group A and 13 cases in group B.Reflux esophagitis:8 cases in group A and 7 cases in group B. [Conclusion] 'Three-incisions' for esophagectomy with position changing during the operation and digestive tract reconstruction through post-sternum canal is a effective method in the treatment of middle-upper esophageal carcinoma. It is superior to the 'Three-incisions' for esophagectomy whithout changing position especially in the time of closing thoracic cavity cardiopulmonary complication, lymph node dissection and symptom of thoracic stomach.