不同手术入路方式治疗食管胃结合部腺癌临床对比研究

The Clinical Comparative Study of Different Surgical Approaches in the Treatment of Adenocarcinoma of the Esophagus and Stomach

目的探究不同手术入路方式治疗食管胃结合部腺癌临床效果及对患者的生存影响。方法方便选取2013年1月—2016年1月在该院治疗食管胃结合部腺癌患者72例,随机均分为试验组和对照组。试验组采取经腹食管裂孔入路方式治疗,对照组采取经胸入路方式治疗。比较两组的手术过程及术后的一些基本情况、淋巴结清扫数目以及患者并发症发生率。结果试验组手术时间(231.5±29.1)min、手术过程中的输血量(312.39±30.12)m L以及住院时间(13.21±0.35)d均少于对照组,差异均有统计学意义(P=0.017、0.023、0.031);试验组淋巴结清扫数目(12.13±0.23)枚,而对照组淋巴结清扫数目(11.78±0.23)枚,差异无统计学意义(P=0.096);试验组的术后并发症:1肺功能不全;2心功能不全;3切缘阳性;4吻合口瘘总发生率8.33%(3/36)低于对照组的38.89%(14/36),(P<0.05)。结论在治疗食管胃结合部腺瘤患者的手术入路方式上,应优先选择经腹食管裂孔入路方式,大大减少了手术时间、手术中输血量以及术后康复时间、术后并发症发生率,值得临床推广。

Objective Binding to explore different surgical approach way in treatment of esophageal and gastric adenocarcinoma of the clinical effect and to the patient＇s survival. Methods Convenient selection a total of January 2013 to January2016 in our hospital treatment of gastroesophageal and 72 cases of adenocarcinoma patients, were randomly divided into experimental group and control group. The experimental group take the keyhole approach in treatment of abdominal esophageal hiatus, were adopted in the control group treated by thoracic approach. Compared with two groups of surgical procedure and postoperative, lymph node dissection and the number of patients with complications incidence.Results（23.15 ± 29.1） min in the experimental group, the operation time and operation process of blood transfusion（312.39 ±30.12） m L and length of hospital stay（13.21 ± 0.35） d were lower than the control group, there was statistically significant difference（P=0.017,0.023,0.031）; test group of lymph node dissection number（12.13 ± 0.23） gold, while the control group of lymph node dissection（11.78 ± 0.23） gold number of pieces, no statistical difference（P = 0.096）; in the experimental group,the postoperative complications： pulmonary insufficiency; II heart function is not complete; third, margin Positive; the total incidence of anastomotic fistula in 8.33%（3/36） lower than 38.89% in the control group（14/36）,（P〈0.05）.Conclusion In the treatment of esophageal gastric with adenoma patients with surgical approach method should be preferred the abdominal esophageal hiatus into the bores on the road way, greatly reducing the operation time, intraoperative blood transfusion and postoperative recovery time, the incidence of postoperative complications, it is worth clinical promotion.