贲门癌手术入路选择的探讨

Surgical approach selection of gastric cardia carcinomas

目的探讨贲门癌手术入路的最佳方法。方法回顾性分析2009年6月至2014年6月间诊治的168例贲门癌手术患者经上腹正中入路或经左胸后外侧入路手术的临床资料,按不同手术入路分为经腹组(102例)和经胸组(66例),比较两组患者的手术效果、有效性指标、并发症发生率及生活质量评分情况。结果两组患者死亡病例、平均清扫淋巴结枚数、上切缘癌阳性残留例数的差异均无统计学意义(均P>0.05)。经腹组患者的手术时间、住院时间短于经胸组,术中出血量少于对经胸组,经腹组患者术后并发症发生率为11.8%(12/102),少于经胸组的30.3%(20/66),差异均有统计学意义(均P<0.05);经腹组患者生活质量优于经胸组,差异有统计学意义(P<0.05)。结论经腹手术对贲门癌患者的效果更佳,值得临床推广。

Objective To investigate the best method of gastric cardia carcinomas operation ap- proach. Methods The clinical data of 168 cases of gastric cardia carcinomas with epigastric midline ap- proach or left chest posterolateral operation in Zanhuang County Hospital from June 2009 to June 2014 were collected. According to the different operation approach, patients were divided into abdominal group （ 102 cases） and transthoracic group （66 cases）. Operation effect, validity index score, complication rate and quality of life between two groups were compared. Results Death cases, average number of lymph node dissection, margin positive residual cancer cases in two groups had no statistical significance （ P 〉 0. 05 ）. Operation time, hospitalization time in transabdominal group were shorter than that in the transthoracic group; Amount of bleeding during the operation in transabdominal group was less than that in the transtho- racic group; Postoperative complication rate in transabdominal group was 11.8% （ 12/102）, which was less than that in transthoracic group （30. 3% ） （20/66）, all with significant difference （P 〈0. 05） ; Quality of life of patients in transabdominal group was better than that of the transthoracic group, with significant difference （P 〈 0. 05 ）. Conclusions Transabdominal operation for patients with gastric cardia carcinomas had better effect, and is worthy of clinical application.