经不同手术径路治疗胸中下段食管鳞癌的比较研究

Comparison of surgical outcomes after different surgical approach for middle or lower thoracic esophageal squamous cancer

目的比较经左胸与右胸手术径路治疗胸中下段食管鳞癌的疗效，探讨合理的胸中下段食管鳞癌手术径路。方法回顾性分析2004年1月到2007年12月间上海交通大学附属胸科医院行手术治疗的120例食管中下段鳞癌患者的临床资料．其中左胸径路和右胸径路各60例．比较两组患者手术切除率、淋巴结清扫情况、术后并发症发生率、复发情况以及生存率。结果左胸径路组和右胸径路组患者手术切除率分别为91．7％（55／60）和95．0％（57／60），差异无统计学意义（P〉0.05）。左胸径路组平均每例淋巴结清扫数和转移淋巴结数分别为4．60枚和0．57枚，显著低于右胸径路组的8．32枚和1．33枚（均P〈0.01）。两组术后并发症发生率分别为26．7％（16／60）和31．7％（19／60），差异无统计学意义（P〉0.05）。两组术后局部复发率分别为43．3％（26／60）和23．3％（14／60）．差异有统计学意义（P〈0.05）：但远处转移率的差异无统计学意义[68.3％（41／60）比56．7％（34／60），P〉0.05]。左胸径路组术后5年生存率为21．7％，明显低于右胸径路组（36．7％，P〈0.05）。结论右胸径路与左胸径路对胸中下段食管鳞癌的手术切除率相似．但右胸径路更易于进行系统性的纵隔淋巴结清扫．有助于减少局部复发、提高长期生存。

Objective To compare outcomes of left and right thoracic incision for middle and lower thoracic esophageal squamous cancer, and to determine reasonable surgical approach for thoracic esophageal squamous carcinoma. Methods One hundred and twenty patients with middle or lower thoracic esophageal squamous cancer who received esophagectomy plus lymphadenectomy between January 2004 and December 2007 were divided into two groups including left （n=60） and right thoracic （n=60） approach. Clinical data were analyzed including the results of surgical resection, lymphadenectomy, postoperative complication, recurrence, and survival. Results The rate of surgical resection was 91.7%（55/60） in the left approach group and 95%（57/60） in the right approach group. There was no significant differenee（P〉O.05）. But the average number of lymph nodes resected （4.60 vs. 8.32） and metastatic lymph nodes （0.57 vs. 1.33.） were both significantly higher in the right approach group （P〈0.01）. There was no statistical difference in postoperative complications [26.7%（16/60） vs. 31.7%（19/60）, P〉0.05] between the two groups. However, the incidence of local recurrence was lower [43.3%（26/60） vs. 23.3%（14/60）, P〈0.05] in the right approach group than that in left- approach group. There was no significant difference in distant metastasis（P〉0.05）. Conclusions The resection rate is comparable between left and right approach for thoracic esophageal cancer. However, it is easier to perform systemic lymphadenectomy via right thoracic approach and therefore the local recurrence is reduced and long-term survival improved.