食管中下段癌手术方式的临床研究

Clinical study of operation for middle-lower segment carcinoma of esophagus

目的探讨食管中下段癌手术方式的合理选择。方法对2003年1月至2005年12月收治的59例食管中下段癌患者,分别采用经左胸后外侧切口切除病变、胃-食管弓上吻合(简称一切口) 25例,经上腹、右胸二切口切除病变、胃-食管胸顶吻合(简称二切口)34例。结果59例患者全部手术切除,无手术死亡。一切口和二切口两种手术方式比较,手术时间分别为(200.80±34.87)min和(210.59±30.84)min,术中出血量分别为(409.00±194.03)ml和(352.94±114.11)ml,差异均无统计学意义(P>0.05);但术中淋巴结清扫数分别为(7.02±4.03)枚和(11.29±4.99)枚,差异有统计学意义(P<0.001)。术后残端癌阳性及吻合口瘘的发生率二切口手术与一切口手术差异无统计学意义。结论经上腹、右胸二切口手术治疗食管中下段癌切除食管长度足够、清扫淋巴结彻底,同时并不增加手术时间及术中出血量,吻合方便,对减少术后并发症也有一定的优势。

Objective To discuss the proper operation style for middle-lower segment carcinoma of esophagus.Methods From Jan.2003 to Dec.2005,59 patients with middle-lower segment carcinoma of esophagus were divided into 2 groups.25 cases were treated with left thoracic approach esophagectomy and esophagogastrostomy above the aortic arch.34 cases were treated with abdominal and right thoracic approach- es esophagectomy and esophagogastrostomy at the top of chest.Results All 59 cases got complete resection. There were no operative mortality.Between the 2 groups,the operation time and the blood loss were 200.80±34.87min vs 210.59±30.84 min(P>0.20),(409.00±194.03)ml vs(352.94±114.11)ml(P>0.10),while the numbers of lymph node dissected was(7.02±4.03)vs(11.29±4.99)(P<0.001).Conclusion By abdominal and right thoracic approaches for middle-lower segment carcinoma of esophagus,we could resect enough length of esophagus and dissect lymph node thoroughly,without increasing the operation time and the blood loss,having easy anastomosis and small surgical complications.