三种术式治疗食管癌的疗效及术后胃食管返流的发生情况

Clinical effects of three surgical procedures on esophageal carcinoma and occurrence of gastroesophageal reflux after operation

目的比较三种术式治疗食管癌的手术疗效及术后胃食管反流发生情况。方法将在医院确诊并通过手术治疗的食管癌患者112例，根据其治疗方式分为三组，接受左外开胸食管胃弓上吻合术治疗的为左切组（A组），接受右开胸、上腹部食管胃吻合术治疗的为双切组（B组），接受右胸、腹中部、左颈三切口食管癌切除术的为三切组（C组），比较三组患者围手术期指标，术后治疗效果、吻合口漏、吻合口狭窄、胃食管反流和肺部等并发症发生率。结果手术时间上，A、C两组差异未见统计学意义（P〉0.05），而B组时间显著长（P〈0.05）；出血量和恢复时间上，A、B两组差异未见统计学意义（P〉0.05），而C组量显著多和长（P〈0.05）；淋巴结扫除总数和肿瘤切除率从高到低依次C组、B组和A组；切缘阳性例数均为2例；三组胃食管反流率均较高，A组吻合口漏最低，B组肺部有并发症率低；C组吻合口狭窄率最低。结论左切术手术时间和恢复时间短、吻合口漏与吻合口狭窄率低，双切术出血量少、肺部并发症率低，三切术淋巴结扫除数目多、肿瘤清除率高，三种术式各有千秋，应根据患者情况选择最佳手术方式。

Objective To compare the clinical effects of three surgical procedures on esophageal carcinoma and occurrence of gastroesophageal reflux after operation.MethodsA total of 112 patients with esophageal carcinoma in our hospital were divided into left resection group （group A）, double resection group （group B） and three resection group（group C）. Group A was treated with left open thoracic esophagus and stomach anastomosis, group B was treated with right thoracotomy and upper abdominal esophagus and stomach anastomosis, and group C was treated with resection of esophageal carcinoma in right chest, regio abdominis media and left neck. After treatment, the perioperative indexes, postoperative curative effects, complication rates of anastomotic leakage, anastomotic stricture, gastroesophageal reflux and pulmonary diseases among the three groups were compared.ResultsThere was no significant difference in operative time between group A and group C（P〉0.05）, but the operative time in group B was obviously longer than that in group A and group C（P〈0.05）; there was no significant difference in blood loss or recovery time between group A and group C（P〉0.05）, but the blood loss and recovery time in group B was obviously more and longer than those in group A and group C（P〈0.05）; the total number of lymph nodes cleaning and rate of tumor resection from high to low were group C, group B and group A; the positive number of incisal edge in the three groups were all 2 cases; the gastroesophageal reflux rates in the three groups were all higher, the group A had the lowest anastomotic leakage rate, the group B had the lowest complication rate of pulmonary diseases, and group C had the lowest anastomotic stricture rate.ConclusionsLeft resection operation has the advantages of less operative and recovery time, and lower anastomotic leakage and stricture rates; double resection operation has the advantages of less blood loss and complication rate of pulmonary diseases; three resection operation has the advantages of more lymph nodes cleaning number and higher tumor resection rate; thus, the best operative method should be selected according to patients’ condition.