右前外侧与左后外侧切口开胸食管癌根治术对肺功能的影响

The influence of radical mastectomy of right anterolateral or left posterolateral incision on the lung function of the esophageal cancer patient

目的探讨右前外侧与左后外侧切口开胸食管癌根治术对肺功能的影响。方法选取择期开胸食管癌根治术患者136例,随机分为观察组与对照组,每组各68例。观察组采用右前外侧切口行食管癌根治术,对照组采用左后外侧切口行食管癌根治术。比较两组患者的手术时间、胸腔开放时间、术中单肺通气时间,分别于术前、术后1周、术后1月检测患者的动脉血气分析和肺功能。结果两组患者手术时间、术前动脉血气分析和肺功能指标比较,差异无统计学意义(P>0.05)。观察组胸腔开放时间、术中单肺通气时间均少于对照组,差异有统计学意义(P<0.05);术后两组患者的血气分析和肺功能指标均呈损伤表现,但观察组较对照组轻微,差异有统计学意义(P<0.05或P<0.01)。结论右前外侧切口开胸行食管癌根治术缩短了术中胸腔开放时间和术中单肺通气时间,且避免了损伤膈肌,因而较左后外侧切口入路对患者肺功能的影响更小,更有利于术后患者肺功能的恢复。

Objective To explore the influenceof radical mastectomy of right anterolateral or left posterolateral incision on the lung function of the esophageal cancer patient. Methods 136 cases that were given elective radical mastectomy of esophageal cancer were selected, and randomly divided into observation group and control group, 68 cases in each group. Patients in observation group were treated with right anterolateral incision, yet patients in control group were treated with left posterolateral incision. Operation time, intraoperative pleural open time, single lung ventilation time of two groups were compared, and their arterial blood gas with pulmonary function were tested before operation, 1 week and 1 month after operation. Results There was no statistical difference on operation time,preoperative arterial blood gas and pulmonary function between two groups （P〉0.05）.Pleural open time, intraoperative single lung ventilation time of observation group was less than that of control group （P〈0.05）.Arterial blood gas and pulmonary function after operation both showed injury in two groups, yet observation group＇s index was slight （P〈0.05 or P〈0.01 ）. Conclusions Radical mastectomy of right anterolateral incision reduces intraoperative pleural open time and single lung ventilation time, also avoids diaphragm injury, and less influence on pulmonary function in esophageal cancer patients when compared with left posterolateral incision, so it is more conducive to patients＇ postoperative pulmonary function recovery.