经腹与经胸入路手术对贲门癌患者术后恢复的影响

Postoperative recovery of different surgical approaches for patients with cardia cancer

目的:研究经腹与经胸入路手术对贲门癌患者术后恢复的影响。方法:收集2006年1月至2016年3月我院诊治的174例贲门癌患者,分为经腹组(76例)和经胸组(98例)。对比研究两组手术时间、术中出血量、清扫淋巴结个数、术后住院时间、住院费用、切缘阳性率、根治率、围手术期病死率及术后并发症率。结果:两组在术中出血量、手术时间比较差异无统计学意义(P>0.05),经腹组淋巴结平均清扫个数多于经胸组(P<0.05),经腹组术后平均住院时间、住院费用低于经胸组(P<0.05)。两组在切缘阳性、手术根治率及围手术期病死率比较差异无统计学意义(P>0.05)。两组在术后气胸、液气胸、脓胸、切口感染及吻合口瘘发生率比较差异无统计学意义(P>0.05),但是经腹组在术后胸腔积液、肺炎、肺部总并发症率及术后总并发症率低于经胸组(P<0.05)。结论:经腹相对经胸入路行贲门癌手术淋巴结清扫更彻底,术后肺部并发症及总并发症率低,术后住院时间短,费用少。

Objective To study the postoperative recovery of different surgical approaches for patients with cardia cancer. Methods From January 20l 1 to March 2016, 174 cases of patients with cardia cancer were selected and divided into observation group （76 cases） and control group （98 cases）. The patients of control group received via thoracic approach surgery, while those of observation group were given abdominal approach surgery. The operation time, intraoperative blood loss, dissected lymph node numbers, postoperative hospital stay, hospitalization expense, positive rate of surgical margin, radical operation rate, perioperative mortality, pulmonary complications, operative incision infection rate and anastomotic fistula rate of two groups were compared. Results There were no significant differences of intraoperative blood loss and operation time, positive rate of surgical margin, radical operation rate, perioperative mortality, postoperative pneumothorax rate, hydropneumothorax rate, pyothorax rate, operative incision infection rate and anastomotic fistula rate between two groups （P 〉 0.05）. There were significant differences of the dissected lymph node numbers, postoperative hospital stay, hospitalization expense, postoperative hydrothorax rate, postoperative pneumonia rate, total pulmonary complications rate and total complications rate between two groups （P 〈 0.05）. Conclusions Abdominal approach for patients with cardia cancer, compared to via thoracic approach surgery, presents advantages in terms of dissected lymph nodes, postoperative hospital stay, hospitalization expense, postoperative pneumonia rate, hydrothrax rate, total pulmonary complications rate and total postoperative complications rate.