食管癌手术入路探讨  

Study of approaches in surgery of esophageal cancer

作　　者：张国庆[1] 孙伟[1] 庞作良[1] 斯坎达尔.阿不力孜 阿地力.萨来 毛拉.艾沙[1] 

机构地区：[1]新疆医科大学附属肿瘤医院胸外科,新疆乌鲁木齐市830011

出　　处：《中国癌症杂志》2005年第1期57-60,共4页China Oncology

摘　　要：目的:改进食管癌的手术入路,提高手术切除率,降低残端癌的发生率、手术死亡率,提高近期手术治疗效果.方法:我院胸外科自1999年1月～2002年12月对297例胸段食管癌患者,分别采用左胸后外侧切口(Ⅰ组)、左胸后外侧切口+左颈切口(Ⅱ组)、右胸前外侧切口(Ⅲ组)、右胸后外侧切口(Ⅳ组)共完成食管癌食管切除术、经食管床食管重建术293例.结果:本组手术切除率98.7%(293/297),Ⅰ组、Ⅱ组、Ⅲ组、Ⅳ组分别为98.2%(86/87)、98.1%(52/53)、98.5%(133/135)、100%(22/22);手术死亡率1.7%(5/297),Ⅰ组、Ⅱ组、Ⅲ组、Ⅳ组分别为2.3%(2/87)、1.9%(1/53)、0.75%(1/135)、4.5%(1/22);断端癌发生率3.8%(11/293),Ⅰ组、Ⅱ组、Ⅲ组、Ⅳ组分别为4.7%(4/86)、3.8%(2/52)、2.3%(3/133)、9.1%(2/22);术后并发症发生率12.8%(38/297),Ⅰ组、Ⅱ组、Ⅲ组、Ⅳ组分别为17.2%(15/87)、9.4%(5/53)、11.1%(15/135)、13.6%(3/22).Ⅲ、Ⅳ组与Ⅰ、Ⅱ组清扫的淋巴结均数相比,差异具有统计学意义(P＜0.05);Ⅰ、Ⅱ组间及Ⅲ、Ⅳ组间清扫的淋巴结均数相比,差异无统计学意义(P＞0.05).结论:食管癌患者右胸前外侧三切口、右胸后外侧三切口全食管切除,可彻底清除胸、腹各组区域淋巴结,有效减少断端癌残留、术后并发症的发生率及死亡率.Purpose:To improve the methads of approach in s urgery of esophageal cancer ,increase resection rate of esophagectomy, decrease the remnant cancer in margin and mortality after operation, enhance the postoper ative effect. Methods:From Jan.1999 to Dec. 2002,we adopted different surgica l approach as in esophagectomy in 297cases with esophageal cancer, such as left posterior thoracotomy(group I), left posterior thoracotomy with cervical incisi on (group Ⅱ),right anterior thoracotomy (group Ⅲ), right posterior thoracotomy (group Ⅳ). Results:The rate of operative resection was 98.7%(293/297)an d for groups Ⅰ, Ⅱ, Ⅲ, Ⅳ they were 98.2%(86/87)、98.1%(52/53)、98.5%(133/135) 、100%(22/22) respectively;operation-related mortality was 1.7%(5/297) and fo r groups Ⅰ, Ⅱ, Ⅲ, Ⅳ it was 2.3%(2/87)、1.9%(1/53)、0.75%(1/135)、4.5%(1/22) respectively;the occurrence of remnant cancer was 3.8%(11/293) and for groups Ⅰ, Ⅱ, Ⅲ, Ⅳ it was 4.7%(4/86)、3.8%(2/52)、2.6%(3/133)、9.1%(2/22) respective ly;the rate of postoperative complication was 12.8%(38/297) and for groups Ⅰ, Ⅱ, Ⅲ, Ⅳ it was 17.2%(15/87)、9.4%(5/53)、11.1%(15/135)、13.6%(3/22) respectiv ely. In the number of lymph node resected , there was statistical difference bet ween groups Ⅲ, Ⅳ and Ⅰ, Ⅱ(P<0.05); there was no statistic difference between groups Ⅲ and Ⅳ, groups Ⅰ and Ⅱ (P>0.05).Conclusions:Right anterior thoracotomy, right posterior thoraco tomy were more satisfactory operative approaches in radical total thoracic esop hagectomy of esophageal carcinoma. Through these two approaches,we not only can resect mediastinal and abdominal lymph nodes radically, but can also decrease t he cancer of at the margin and mortality after operation.

关 键 词：食管癌 食管切除术 食管重建术 

分 类 号：R735.1[医药卫生—肿瘤]