经左胸小切口联合管状胃重建在老年食管癌患者根治术中应用

Left transthoracic small incisions in combination with tubular gastrectomy for radical esophageal cancer surgery in elderly patients

目的探讨经左胸小切口联合管状胃重建在老年人食管中下段癌根治术中的应用价值。方法采用回顾性分析方法，收集2012年1月至2014年9月在江南大学附属医院胸心外科接受经左胸食管中下段癌根治切除术老年患者（≥70岁）的临床资料，其中经左胸小切口联合管状胃代食管术38例（管胃组），常规左后外侧切口全胃代食管术45例（全胃组），对比两组患者的临床治疗效果。结果管胃组与全胃组比较，术中出血量（204．3±75．4）ml比（258．4±80．2）ml（t=2．720），术后第1天及第2天胸腔引流量（201．7±82．6）ml比（320．5±78．1）ml（t=3．221）及（150．8±83．0）ml比（244．6±81．2）ml（t=3．189），术后第3天疼痛评分（3．73±1．02）分比（5．24±1．15）分（t=2．858）及心律失常13．2％比33．3％（x2=4．588），肺部并发症18．4％比46．7％（x2=7．353），胃食管反流23．7％比55．6％（x。：8．654）及胃排空障碍0．0％比11．1％（x2=4．493）等，管胃组均优于全胃组（均P〈0．05）；而两组在手术时间、术后住院天数、吻合口瘘、吻合口狭窄及1年生存率等方面比较，差异无统计学意义（P〉0．05）。结论经左胸小切口联合管状胃重建在老年食管中下段食管癌根治术中的临床治疗效果突出，显著降低手术创伤，减少术后并发症，提高生活质量，有助于患者术后康复。

Objective To investigate the application of left transthoracic small incisions in combination with tubular gastrectomy for radical esophageal cancer surgery in elderly patients . Methods Clinical data of 83 patients with carcinoma in the middle or lower third of the esophagus aged ≥ 70 years who had undergone radical surgery at our hospital from January 2012 to September 2014 were collected. Patients were divided into two groups： the tubular gastrectomy group （n= 38） which had undergone radical surgery through left transthoracic small incisions in combination with tubular gastrectomy and the stomach group （n = 45） which had been treated with esophagectomy through conventional left posterolateral incisions and esophageal reconstruction with the remnant stomach. Clinical outcomes were compared between the two groups. Results Compared with the stomach group,operative blood loss [（204.3±75.4） ml vs. （258.4±80.2） ml,t=2. 720,P〈0. 05], chest drainage on the first and second postoperative day [（201.7±82.6） ml vs. （320.5±78.1） ml, （150.8±83.0） ml vs. （244.6±81.2） ml,t=3.221 and 3. 189,respectively,each P〈0.05],pain scores on the third postoperative day [（3. 73 ±1. 02） vs. （0.24±1.15）,t= 2. 852,P〈0.05], incidence of arrhythmia （13.2% vs. 33.3% ,x2 =4. 585,P〈0.05） ,pulmonary complications （18.4% vs. 46.7%,x2= 7. 353, P〈 0.05） and incidences of gastroesophageal reflux and gastric emptying disorders （23.7% vs. 55.6G,0.0% vs 11.1%,x2=8.654 and 4. 493, both P〈0.05） were less or lower in the tubular gastrectomy group. The two groups had no significant difference in operation time,length of hospital stay,anastomotic leakage, anastomotic stenosis or 1-year survival rate （each P 〉0.05）. Conclusions Radical surgery with small incisions through the left chest combined with tubular gastrectomy shows highly favorable clinical outcomes in elderly patients with middle or lower esophageal cancer,and can significantly reduce surgical trauma, decrease postoperative complications,improve the quality of life,and help patients recover after surgery,