胸中段食管癌患者手术入路对手术效果及术后并发症的影响

Effect of operative approaches on operative results and postoperative complications in patients with mid-thoracic esophageal carcinoma

目的探讨不同手术入路对胸中段食管癌患者手术效果及术后并发症的影响。方法我院行外科手术治疗的56例胸中段食管癌患者,根据手术入路分成A(n=26)、B(n=30)两组,A组行经左胸两切口(左胸、颈部)入路治疗方案,B组行经右胸三切口(右胸、上腹部、左颈部)入路治疗方案。对比两组围术期指标、肿瘤切除情况、术后并发症发生情况及3年随访情况。结果两组肿瘤R0切除率、术后并发症发生率及术后引流时间、总引流量、总住院时间等围术期指标比较,差异均无统计学意义(P>0.05);A组手术时间、术中失血量及淋巴结清扫个数均低于B组(P<0.05)。3年随访期内,A组纵膈淋巴结复发率高于B组,无复发生存率低于B组(P<0.05)。结论两种入路方案在胸中段食管癌的临床治疗中各有利弊,需综合考虑患者实际情况后合理选择。

Objective To explore the effects of different operative approaches on the operative results and postoperative com- plications in patients with mid-thoracic esophageal carcinoma. Methods The clinical data of 56 patients with mid-thoracic esophageal carcinoma who underwent surgical treatment were retrospectively analyzed. According to operative approach, the patients were divided into group A （n=26） and B （n=30）. The group A was treated by trans-left-chest two-incision （left chest,neck） approach while group B was treated by trans-right-chest.three-incision （right chest, upper abdomen and left neck） approach. The perioperative indexes, status of tumor resection, incidence of postoperative complications and 3-year follow-up were compared between the two groups. Results There were no significant differences in the rate of tumor R0 resection,incidence of postoperative complications, postoperative drainage time, total volume of drainage and total duration of hospitalization between the two groups （P 〉 0. 05 ）. The operation time, intraopera- tive blood loss and number of lymph node removed in the group A were significantly lower than those in the group B （ P 〈 0. 05 ）. Dur- ing the period of 3 years of follow-up, the recurrence rate of mediastinal lymph nodes in the group A was significantly higher than that in group B while the recurrence free survival rate was significantly lower than that in group B （P 〈 0. 05）. Conclusion The two approa- ches have their own advantages and disadvantages in the clinical treatment of mid-thoracic esophageal carcinoma. The reasonable choice should be made according to the actual situation of the patients.