食管癌不同入路开胸手术选择及对淋巴结清扫效果分析

Thoracotomy through different approaches for patients with esophageal cancer and the effects of lymph node dissection

目的 探讨食管癌不同入路开胸手术的选择及对淋巴结清扫效果.方法 选取本院2013年2月至2015年2月收治的78例食管癌患者为研究对象,采用随机数表法将患者分为观察组与对照组,每组39例.观察组采用右胸前外侧腹正中入路二切口术式,对照组采用左胸后外侧入路,对两组手术一般指标、术中淋巴结清扫效果及术后并发症发生情况进行比较.结果 观察组手术时间、术中出血量及住院时间分别为（197.66±38.72） min、（226.43±19.77） ml、（14.76±2.36）d,与对照组比较显著较高（P＜0.05）;观察组术中清扫淋巴结数及病检发现转移性淋巴结数分别为（19.34±3.57）枚、（16.67±2.24）枚,与对照组比较均显著较高（P＜0.05）;观察组术后并发症发生率为25.64％,与对照组（7.69％）比较显著较高（P＜0.05）.结论 右胸前外侧腹正中入路食管癌根治术对淋巴结清扫效果更好,但与左胸入路相比,手术创口较大,术中出血量多,并且术后并发症较多.

Objective To explore the efficacy of thoracotomy through different approaches for patients with esophageal cancer and the effects of lymph node dissection.Methods 78 patients with esophageal cancer treated at our department from February,2013 to February,2015 were selected as study objects and were randomly divided into an observation group （39 cases） and a control group （39 cases）.The observation group were treated with two incision operation through right lateral thoracic abdominal midline approach and the control group with operation through left thoracic posterior lateral approach.The general indexes,effects of lymph node dissection,and incidence of postoperative complications were compared between these two groups.Results The operation time,intraoperative bleeding volume and hospital stay were （197.66 ± 38.72） min,（226.43 ± 19.77） ml and （14.76-±2.36） d in the observation group,respectively,which were significantly higher than those in the control group （P〈0.05）.The numbers of dissected lymph nodes and metastatic lymph nodes were （19.34 ± 3.57） and （16.67 ± 2.24） in the observation group,respectively,which were significantly higher than those in the control group （P〈0.05）.The incidence of postoperative complications was 25.64% in the observation group,which was significantly higher than that in the control group （P〈0.05）.Conclusions Compared with the operation through left thoracic posterior lateral approach,the one through right lateral thoracic abdominal midline approach has better effect on lymph node dissection in patients with esophageal cancer,but its disadvantage is more surgically invasive,intraoperatively bleeding more,and having higher incidence of postoperative complications.