右胸加上腹正中两切口食管癌根治术疗效观察

Radical correction through right chest and middle of upper abdomen for esophageal cancer

目的:观察经右胸、上腹正中切口,食管-胃右侧胸顶吻合术治疗中下段食管癌的疗效,探讨该术式的优势。方法:2006年6月-2011年6月经上腹正中、右胸两切口食管癌根治术治疗中、下段食管癌142例的吻合口瘘、吻合口狭窄、食管切缘阳性以及淋巴结清扫情况进行回顾性分析。结果:根治性切除率95.5%,晚期病例根治切除率90.5%,无手术死亡,无吻合口瘘及狭窄,吻合口出血3例,1例发生胃小弯侧应激性溃疡出血并穿孔。淋巴结清扫846枚,转移淋巴结235枚,淋巴结转移率27.8%;其中锁骨下动脉旁淋巴结和喉返神经旁淋巴结86枚,转移淋巴结16枚,转移率18.6%。结论:经右胸、上腹正中切口行食管癌切除手术,具有手术野显露清楚,直视下吻合口可靠且无张力,肿瘤切除率高,淋巴结清扫较为彻底,保持隔肌完整性,患者术后咳嗽排痰容易,能够减少肺部并发症发生,值得临床推广使用。

Objective：To observe the clinical effect of radical correction through the two incision of right chest and middle of upper abdomen for mid or lower portion esophageal cancer and explore the clinical advantages of this operation mode.Methods：The data of 143 cases with mid or lower portion esophageal cancer underwent radical correction of two incision were retrospectively analyzed.Results：The radical resection rate was 95.5%,and the radical resection rate in advanced case was 90.5%.There was no dead case,no anastomotic fistula,3 cases with anastomotic bleeding and 1 case with the lesser curvation of the stomach with stress ulcer bleeding and perforation.Lymph node dissection in total were 846,mestastatic lymph node number was 235,the rate of lymph node metastasis was 27.7%.Among them,subclavian artery lymph node and recurrent laryngeal nerve lymph were 86 and mestastatic lymph node number was 18,the rate of lymph node metastasis was 18.6%.Conclusion：Radical correction through the two incision of right chest and middle of upper abdomen for esophageal cancer can reduce the pulmonary complications,with excellent exposure,high respectability and reliable anastomosis,keep the diaphragmatic integrity,thorough removal of required lymph nodes and the patients can discharge sputum easily.