左胸入路与右胸入路行食管癌切除术对淋巴结清扫情况及患者预后的影响

Effect on Lymph Node Clearance and Stress Hormone Levels and 5-year Survival Rate in Patients Undergoing Radical Resection of Esophageal Carcinoma via the Left Versus Right Thoracic Approach

目的探讨左胸入路与右胸入路行食管癌切除术对淋巴结清扫情况及患者5年生存率的影响。方法选取行食管癌切除术治疗的150例食管癌患者,根据手术入路将150例患者分为观察组(75例,右胸入路)和对照组(75例,左胸入路)。比较两组围手术期相关手术指标(术中出血量、手术时间、术后引流管置管时间、住院时间)、淋巴结清扫情况、应激激素水平变化[肾上腺素(EP)、促肾上腺皮质激素(ACTH)、皮质醇(COR)]、并发症发生率(术口感染、肺部感染、肺不张、心律失常、吻合口瘘、呼吸衰竭)、5年生存率及生存期。结果观察组术中出血量、淋巴结清扫个数比对照组多,手术时间比对照组长,差异均有统计学意义(P<0.05)。术后3 d,观察组应激激素指标EP、ACTH、COR水平均比对照组高,差异均有统计学意义(P<0.05)。观察组术口感染、肺部感染、肺不张等并发症总发生率为25.33%,对照组总发生率为45.33%,观察组明显较对照组低,差异有统计学意义(P<0.05)。观察组5年生存率(40.00%)明显比对照组(18.67%)高,术后生存期比对照组长,差异均有统计学意义(P<0.05)。结论与左胸入路行食管癌切除术相比,右胸入路治疗虽然手术时间更长,术中出血量更多,术后应激反应更强,但淋巴结清扫更彻底,患者术后并发症发生率更低,远期疗效更好。

Objective To discuss the effect on lymph node clearance and stress hormone levels and 5-year survival rate in patients undergoing radical resection of esophageal carcinoma via the left versus right thoracic approach.Methods 150 patients underwent radical resection of esophageal carcinoma were selected,and divided into the observation group(right thoracic approach)and the control group(left thoracic approach)according to the different surgical approaches,each with 75 cases.Then the perioperative related surgical indicators(intraoperative blood loss,operative time,postoperative catheter insertion time,length of stay),lymph node clearance,changes in stress hormone levels[epinephrine(EP),adrenocorticotropic hormone(ACTH),cortisol(COR)],complication rates(intraoperative incision infection,pulmonary infection,pulmonary atelectasis,arrhythmia,anastomotic fistula,respiratory failure),5-year survival rate and survival time were compared between the 2 groups.Results The intraoperative blood loss and the number of lymph dissection in the observation group were more than those in the control group,and the operative time was longer than that in the control group,with statistical significance(P<0.05).Three days after surgery,stress hormone EP,ACTH and COR levels in the observation group were higher than those in the control group,with statistical significance(P<0.05).The total incidence of complications including incision infection,pulmonary infection and atelectasis was 25.33%in the observation group,which was lower than 45.33%in the control group(P<0.05).The 5-year survival rate was 40.00%in the observation group,which was higher than 18.67%in the control group,indicating a longer postoperative survival time in the observation group than in the control group(P<0.05).Conclusion Compared with left thoracic approach for radical resection of esophageal carcinoma,right thoracic approach has a lower incidence rate of postoperative complications and better long-term efficacy in patients,despite the longer surgical time,more intraoperative bleeding,and strong postoperative stress response.