左右胸不同路径手术对胸中段食管癌患者的治疗效果研究.docVIP

左右胸不同路径手术对胸中段食管癌患者的治疗效果研究 [摘要] 目的 分析比较左右胸不同路径手术对胸中段食管癌患者的治疗效果。方法 将我院施行手术的120例胸中段食管癌患者分为观察组与对照组各60例，观察组作右胸、腹部、颈部三切口手术；对照组行单纯左胸入路手术。分析比较两组患者的手术时间、术后住院及留置胸管时间、淋巴结清除数目、食管残端阳性率、术后并发症及2年存活率等指标。结果 观察组手术时间、术后住院时间、清除淋巴结数目及2年存活率明显高于对照组；食管残端阳性率显著低于对照组（P 0.05）；观察组术后肺部感染及吻合口瘘发生率较高（P 0.05）。 结论 与单纯左胸入路手术相比，经右胸、腹部、颈部三切口的右胸路径手术的疗效更佳，对上纵隔及腹腔的淋巴结清除更彻底，不易复发，2年存活率高，但手术耗时较长，术后肺部感染及吻合口瘘发生率偏高，应根据患者具体情况选择适宜的手术路径。 [关键词] 右胸路径手术；左胸入路；中段食管癌 [中图分类号] R655.4；R735.1 [文献标识码] B [文章编号] 1673-9701（2014）27-0005-03 [Abstract] Objective To compare and analyze the surgical efficacy of different ways of left and right transthoracic approaches on patients with middle thoracic esophageal cancer. Methods The 120 patients with middle esophageal carcinoma were divided into observation group （60 cases） and the control group （60 cases） randomly. The patients in observation group were treated with right chest-belly-neck three-incision. The control group accepted left breast single incision. The operation duration， postoperative hospitalization time and indwelling chest tube time， the number of lymph node dissection， the rate of proximal spread of tumor， incidence of postoperative complications and 2-year survival rate were recorded and analyzed. Results Compared with control group， the operation duration， postoperative hospitalization time， the number of lymph node dissection and 2-year survival rate in observation group were higher. The rate of proximal spread of tumor in observation group were lower than in control group（P 0.05）. The incidence of pulmonary infection and anastomotic leak were higher （P 0.05）. Conclusion Compared with left breast single incision， right chest-belly-neck three-incision can provide a wider extent of lymphadenectomy， especially for mediastinal and abdominal， which may improve the survival in two years of patients with middle esophageal carcinoma. But the operation time may be longer and the incidence of pulmonary infection and anastomotic leak may be higher. Surgery should be se