贲门癌手术路径的选择及手术效果的比较研究

Comparative Study on Surgery Path Selection and Curative Effect of Cardia Cancer

目的:讨论贲门癌三种手术路径的选择并对手术效果进行比较。方法:回顾性的分析了我院2010年2月至2014年10月收治的157例贲门癌手术患者。对三种手术路径的手术效果及术后并发症等指标进行分析比较。结果:经胸、胸腹联合、单纯经腹三种手术路径的手术切除率分别为92.7%、100%和94.1%(x2=2.452,P>0.05),平均清扫淋巴结数目分别为(11.4±4.3)、(15.3±4.1)和(14.6±4.7)(F=3.732,P>0.05),吻合口瘘发生率分别为3.6%、2.9%和2.9%(x2=0.056,P>0.05),切缘癌残留率分别为1.8%、0和2.9%(x2=1.050,P>0.05),心肺并发症发生率分别为5.5%、5.9%和4.4%(x2=0.124,P>0.05),三组患者在手术切除率、平均清扫淋巴结数目、吻合口瘘发生率、切缘癌残留率和心肺并发症发生率方面差异均不具有统计学意义。三种手术路径的术后平均住院时间分别是(14.6±5.6)d、(15.1±4.3)d、(9.7±2.5)d,单纯经腹手术患者的平均住院时间最短(F=8.962,P<0.05)。结论:三种贲门癌的手术路径各有利弊,临床实际应用中要在确保原发肿瘤得以根治切除及清扫周围淋巴结的前提下依据病人上消化道造影、胃镜检查情况选择合适的手术路径。

Objective： To discuss the choice of three kinds of surgery path in the operation of cardiac cancer and compare the operation effect. Methods： A retrospective analysis was performed in 157 cases of cardiac cancer operation patients in our hospital from February 2010 to October 2014. The operation effect and incidence of postoperative complications was analyzed and compared. Results：The operation resection rate of transthoracic, combined thoraco-abdominal, transabdominal paths were 92.7 %, 100 % and 94.1 %, respectively（Х^2=2.452, P〈0.05）, and the average number of lymph nodes were（11.4 ＋ 4.3）,（15.3 ＋ 4.1） and（14.6 ＋ 4.7（F=3.732, P 0.05）, the anastomotic leakage rate were 3.6 %, 2.9 % and 2.9 %（Х^2=0.056, P 0.05）, the residual cancer rate were respectively 1.8 %, 0and 2.9 %（Х^2=1.050, P〉0.05）, the incidence of complications of heart and lung were 5.5 %, 5.9 % and 4.4 %（Х^2=0.124, P〈 0.05）, and there were no statistical difference among three groups in the resection rate, the average number of lymph nodes, the incidence of anastomotic fistula, the rate of residual cancer and the incidence of cardiopulmonary complications. The average postoperative hospital stay of three kinds were（14.6 ＋ 5.6） d,（15.1 ＋ 4.3） d,（9.7 ＋ 2.5） d, the average hospitalization time of patients treated with transabdominal path was the shortest（P〈0.05）. Conclusions： Each of the three kinds of operation path for cardia cancer has its advantages and disadvantages in clinical practice, so we need select proper operation path under the digestive tract endoscopy to ensure the radical resection of primary tumor and clean lymph nodes.