不同入路食管癌切除术治疗胸中下段食管鳞癌的效果对比

Comparison of the Effect of Different Approaches of Esophageal Carcinoma Resection in the Treatment of Middle and Lower Thoracic Esophageal Squamous Cell Carcinoma

目的比较不同入路食管癌切除术治疗胸中下段食管鳞癌(ESCC)的效果。方法选择96例ESCC患者,按随机对照原则分为两组,各48例。两组患者均行食管癌切除术治疗,左胸组采取左胸入路,右胸组采取右胸入路。比较两组患者手术相关指标(手术时间、术后住院时间、术中失血量、淋巴结清扫)、并发症发生情况(心律失常、心功能不全、肺炎、呼吸衰竭、伤口感染、吻合口瘘、胃排空障碍)及远期疗效(生存期、5年生存率)。结果治疗后,右胸组手术时间长于左胸组,术中失血量多于左胸组,且淋巴结清扫多于左胸组,差异有统计学意义(P<0.05);两组术后住院时间比较,差异无统计学意义(P>0.05);治疗后,右胸组并发症发生率25.00%,低于左胸组45.83%,差异有统计学意义(P<0.05);治疗后,右胸组生存期长于左胸组,5年生存率39.58%,高于左胸组18.75%,差异有统计学意义(P<0.05)。结论右胸入路行食管癌切除术虽然手术时间较左胸入路长,术中出血量较左胸入路多,但右胸入路淋巴结清扫更彻底,术后并发症发生率较低,且远期疗效更佳。

Objective To compare the effect of different approaches of esophageal carcinoma resection in the treatment of middle and lower thoracic esophageal squamous cell carcinoma(ESCC).Methods 96 ESCC patients were selected,by the random number table method,they were divided into 2 groups,48 cases in each group.Both groups were treated with resection of esophageal carcinoma,the left thoracic approach was adopted in the left chest group and the right thoracic approach was adopted in the right chest group.The operation related indicators(operation time,postoperative hospital stay,intraoperative blood loss,lymph node dissection),the occurrence of complications(arrhythmia,cardiac insufficiency,pneumonia,respiratory failure,wound infection,anastomotic leakage,gastric emptying disorder)and long-term efficacy(survival period,5-year survival rate)of patients in the 2 groups were compared.Results After treatment,the operation time of the right chest group was longer than the left chest group,intraoperative blood loss was more than the left chest group,and lymph node dissection was more than the left chest group,with a statistical significant difference(P<0.05);compared the postoperative hospital stay of both groups,the difference was not significant statistically(P>0.05);after treatment,the incidence of complications in right chest group was 25.00%,which was lower than 45.83%in the left chest group,with a statistical significant difference(P<0.05);after treatment,the survival time of the right chest group was longer than the left chest group,and the 5-year survival rate was 39.58%,which was higher than 18.75%of the left chest group,with a statistical significant difference(P<0.05).Conclusion Although the operation time of right thoracic approach of esophageal carcinoma resection is longer,the amount of intraoperative blood loss is more than that of left thoracic approach,the right thoracic approach is more thorough,the incidence of postoperative complications is lower,and the long-term effect is better.