右颈、右胸、上腹正中三切口治疗胸上、中段食管癌的临床观察

Use of Tripleincision in the Resection of Upper or Middle Third Esophagus Cancer

１９９２年４月～１９９６年６月期间，采用右颈、右胸、上腹正中三切口治疗２２６例和左胸切口治疗２５７例胸上、中段食管癌的对照临床资料，经统计学处理，右胸切口切除率、喉返神经损伤比左胸切口高，Ⅲ期病例明显增多；左胸切口的乳糜胸、０期、Ⅰ期、Ⅱ期、奇静脉和气管膜部损伤病例比右胸切口多。而并发症、颈部吻合口瘘、食管固有动脉损伤、切口感染和死亡例数等无差异。资料表明，右胸切口具有显露满意，切除率高，游离受侵的组织器官方便，不切开膈肌术后对咳嗽排痰有利，胸内操作和开胸时间短等优点。不失为胸上、中段食管癌尤其是Ⅲ期病例的首选切口。

From April 1992 to June 1996, in 226 cases of upper or middle third esophageal cancer, Tripleincision (right neck, right thorax and median abdominal incisions) was used (group A), and in 257 cases, conventional left side incision was used (group B). The results showed that the resectability and injury of recurrent laryngeal nerve in group A were higher than those in group B (P< 0.05～0.01). The incidence of the above complications increased apparently in stage III patients. Chylothorax, injuries of paradoxical vein and membranous part of the trachea in stage 0, I, II patients were higher in group B (P<0.01); but there was no difference in incidence of the complications of cervical anastomotic leakage,injury of esophageal basal artery, incisional infection and mortality between these two groups (P>0.05). The right side tripleincision has the advantages of good exposure, higher resection rate, easy dissection of invasion tissue without opening diaphragm and save time.