3种术式治疗胸中段食管癌的近期疗效及安全性评价

The short-term efficacy and security of three types of surgeries to treat middle thoracic esophageal carcinoma

目的:对比分析3种不同食管癌根治术治疗胸中段食管癌的近期疗效及安全性。方法:选取2013年6月至2015年6月在陕西省延安大学咸阳医院胸外科接受食管癌根治术治疗的胸中段食管癌患者97例,根据手术方式不同分为3组:左胸单切口手术组(A组,41例),左颈—左胸双切口手术组(B组,32例),左颈—右胸—腹正中三切口手术组(C组,24例)。对比3组患者的手术情况、近期疗效及并发症发生情况。结果:C组的手术时间显著长于A组和B组,且术中出血量和淋巴结清扫数目均明显多于A组和B组(均P<0.05)。C组的肺部感染率明显高于A组和B组(P<0.05),淋巴结转移率、局部复发率均明显低于A组和B组(均P<0.05)。3组并发症总发生率及1年生存率比较差异均无统计学意义(均P>0.05)。结论:三切口术式治疗胸中段食管癌的淋巴结清扫较左胸单切口及左颈—左胸双切口更为彻底,可降低淋巴结转移率及局部复发率。

Objective： To evaluate and compare the clinical efficacy and safety of three types of radical surgeries for esophageal carcinoma. Methods： 97 patients with middle thoracic esophageal carcinoma who underwent esophageal carcinoma resection in our hospital from June 2013 to June 2015 were selected and divided into 3 groups according to different surgical approaches： the patients underwent the left rear outer in cision were defined as group A （ n =41）, those underwent the left neck and left chest incision surgery were defined as group B （ n = 32 ）, and those underwent left neck-right chest-ventral midline incision surgery were defined as group C （ n = 24）. The short-term efficacy and incidence of complications between the three groups were compared. Results： The surgical duration and blood-loss volume in group C were significantly higher than those in group A and group B （ P 〈0.05）. The number of lymph node dissection in group C was significantly higher than that in group A and group B （ P 〈0.05）. The lung infection rate in group C was statistically higher than that in group A and group B （ P 〈0.05）. There were no significant differences in the total incidence of complications and one-year survival rate among the 3 groups （ P 〈0.05）. Conclusion： With the three-cut approach, the lymph node dissection was more thoroughly. It could effectively reduce the risk of lymph node metastasis and local recurrence.