全胸段食管切除对胸下段食管癌患者术后生存率影响的临床研究

Clinic study of total esophagectomy postoperatively on survival rate of esophageal cancer

目的：探讨全胸段食管切除与胸中下段食管切除对食管癌患者术后生存率的影响，确定食管癌根治术的最佳手术入路，提高患者手术后长期生存率。方法：我院胸外科1999年1月～2001年12月对193例胸下段食管癌患者，行左胸后外侧切口（Ⅰ组）67例，行左胸后外侧切口＋左颈切口（Ⅱ组）65例，行三切口（Ⅲ组）155例，完成食管癌食管切除术、经食管床食管重建术。结果：Ⅰ组患者术后1、3和5年生存率分别为77．14％、78．43％和82．54％，Ⅱ组分别为62．62％、58.36％和61.09％，Ⅲ组分别为38．12％、39．32％和42．07％。三组患者术后1、3年生存率差异无统计学意义，P〉0．05。Ⅰ、Ⅲ组间5年生存率差异有统计学意义，P〈0．05。Ⅰ、Ⅱ组间及Ⅱ、Ⅲ间5年生存率差异无统计学意义，P〉0．05。结论：胸下段食管癌病例采取三切口的手术入路，5年生存率高于左胸后外侧切口组，且与左胸＋左颈二切口相比，长期生存率显示增高的趋势。对于胸下段食管癌病例，应选择三切口手术入路。

OBJECTIVE： To discuss the efficiency of the tatol esophagectomy on the long-survival rate of esophageal cancer, determine the best approach for lower segment of thoracic esophageal cancer and increase the postoperative survival rate of esophagectomy. METHIDS： From Jan 1999 to Dec 2001, We adopted different surgical approaches of esophagectomy in 193 cases with esophageal cancer, such as left posterior thoracotomy （group Ⅰ） in 67 cases, left posterior thoracotomy plus cervical incision （group Ⅱ） in 65 cases, right anterior thoracotomy （group Ⅲ） in 61 cases. 1,3,5-years postoperative survival rate were compared between the three groups. RESULTS： 1,3,5-years postoperative survival rate were 77.14%, 78.43%, 82.54%, 62.62%, 58.36%, 61.09% and 38.12%, 39.32%, 42.07% in group Ⅰ,Ⅱ,Ⅲ respectively; The 1,3-years survival rate was found no statistic difference between three groups, P〉0.05. The 5-year survival rate was statistically different between group Ⅰ and group Ⅲ, P〈0.05; there were no statistic difference between group Ⅰ and Ⅱ （P〉0.05）; no statistic difference were found between group Ⅱ and group Ⅲ, P〉0.05; but the trend of postoperative survival rate in group Ⅲ was seemly longer than that of group Ⅰ and Ⅱ. CONCLUSIONS： Right anterior thoracotomy was a better approach in totally thoracic esophagectomy of esophageal carcinoma. Compared with left posterior thoracotomy （group Ⅰ） and left posterior thoracotomy with cervical incision （group Ⅱ）, right anterior thoracotomy might prolong postoperative survival rate in the patient with esophageal cancer.