高龄食管癌两种手术方式的临床分析

Elderly esophageal cancer clinical analysis of two surgical methods

目的探讨两种手术方式治疗高龄食管癌患者的疗效及预后。方法将114例≥75岁食管癌手术治疗者随机分为两组,A组32例选择直接食管癌根治、食管胃吻合术,其中颈胸腹三切口手术16例,右胸上腹两切口手术11例,左胸单切口5例;B组82例分两期手术(一期行食管癌切除、食管左颈部外置、胃造瘘术;择期行二期手术即胸骨后胃代食管、食管胃左颈吻合术)。比较两组疗效及并发症发生率。结果 A组手术时间(2.9±0.7)h,出血量(305±65)ml,术后共发生各类并发症25例,死亡3例;B组一期手术平均手术时间(2.1±0.4)h,平均出血量(220±60)ml,术后共发生各类并发症22例,死亡2例。两组比较,差异有统计学意义(P<0.05)。结论对≥75岁特别是心肺功能欠佳、食管病灶广泛或位于中上段的食管癌患者采用分期手术,术后风险相对较小,恢复较快,有利于术后辅助治疗。

Objective To investigate the therapeutic and prognostic effect of two kinds of surgical treatment on elderly patients with esophageal cancer.Methods One hundred and fourteen cases of esophageal cancer patients who ≥ 75 years were randomly divided into two groups： A group includes 32 patients opt for direct esophageal cancer,esophageal anastomosis,in which the neck chest and abdomen three incision in 16 cases,right chest,upper abdomen two incision in 11 cases,single left chest incision five cases;B group inculdes 82 cases of surgery in two phases（a line of resection of esophageal cancer,esophageal left neck external,gastrostomy;elective surgery that is,two chest stomach esophagus,left cervical esophagogastric anastomosis）.The efficacy and complication rates were compared between two groups.Results In group A,mean operative time was（2.9±0.7）h,mean blood loss was（305±65）ml,postoperative complications occurred in various types of 25 cases,3 patients were died;while in B group,an average operative time of surgery was（2.1±0.4）h,mean blood loss was（220±60）ml,postoperative complications occurred in various types of 22 cases,2 patients were died.There was a significant difference between two groups（P〈0.05）.Conclusion For patients ≥ 75 years in particular,poor cardiopulmonary function,esophageal lesions in a wide range or upper esophageal cancer,the risk of stage surgery is relatively small.The patients can fast recovery and are beneficial adjuvant therapy.