食管癌切除胃代食管术两种径路疗效及生活质量的评价

Evaluation of postoperative effects and living quality by taking two-cut and three-cut esophageal carcinoma resection with replacement of esophagus by stomach

目的 探讨二切口与三切口食管癌切除胃代食管术疗效及生活质量。方法 回顾性分析 1988年 7月～ 1996年 7月行食管癌切除胃代食管术 786例的临床资料 ,其中经左颈胸二切口 5 94例 ,经右颈胸腹三切口 192例。结果 三切口组术后并发症、死亡率明显高于二切口组 (P <0 0 5 ) ,术后 1、3、5年生存率偏低于二切口组 ,无统计学意义 (P >0 0 5 )。但淋巴结阴性与阳性之间比较 ,5年生存率有极显著性差异 (P <0 0 1)。两组术后生活质量比较 ,三切口组术后进食量、进食后胸闷不适、体重下降等 3项指标与二切口组之间差别具有显著性的意义 (P <0 0 5 )。结论 胃代食管术对患者术后生活质量有很大影响 ,三切口组表现更为明显 ,采用胸胃缩缝、并与纵隔胸膜缝合固定可明显改善术后近期生活质量。加强对早期食管癌的诊断与治疗 。

Objective: To investigate the postoperative effects and living quality by taking two cut and three cut esophageal carcinoma resection with stomach Methods: 786 cases of esophageal carcinoma resection withreplacement of esophagus by stomach including 594 cases with two cut through left check and chest as well as 192 cases with three cut throuth right?check?chest and abdomen between July 1988 and July 1996 were examined retrospectively Results: Postoperative complication and the mortality were obviously higher in three cut group than those in two cut group(P<0 01) The survival rates in three cut group were lower after the 1 st?3 rd?5 th year than those in the two cut group, but there's no statistic significance (P>0 05) However, there was significant difference in the survival rate in the 5 th year when compared the positive of lymph node with the negative (P<0 01) Meanwhile, there were significant differences in such three indexes of postoperative living guality as food amount, chest distress after meal and lower weight (P<0 05) Conclusion: The results are connected with the two operative ways The replacement of esophagus by stomach operation, especially with the three cut, has great effect on the patient's living quality The operations by stitching curled stomach and fixing it with mediastinal pleura by stitching again, improve the quality of the pationts' life evidently So the key to increasing long term survival rate is to strengthen the diagnosis of and treatment for premature esophageal carcinoma