胸段食管癌手术径路的个体化选择  

Individualized selection of the operative approaches to thoracic esophageal carcinoma

作　　者：周源[1] 汪栋[1] 韩开宝[1] 孙宏志[1] 许罡[1] 路东明[1] 张剑锋[1] 

机构地区：[1]解放军八一医院胸心外科,南京210002

出　　处：《临床肿瘤学杂志》2012年第1期32-35,共4页Chinese Clinical Oncology

摘　　要：目的探讨胸段食管癌手术径路选择个体化的意义。方法回顾性研究2007年1月至2009年1月共456例胸段食管癌根治患者的临床资料,分析不同手术径路对肿瘤根治性与术后并发症的影响。结果全部患者均顺利完成食管癌根治术,其中左胸后外侧开胸+左颈部切口(Ⅰ组)268例,单纯左胸后外侧开胸(Ⅱ组)42例,右胸后外侧开胸+上腹部正中切口(Ⅲ组)94例,右胸前外侧开胸+上腹部正中切口+颈部切口(Ⅳ组)52例。胸上段癌59例中,Ⅳ组43例,Ⅰ组16例(临床分期T1-2N0M0);中段癌316例中,Ⅰ组231例,Ⅲ组76例,Ⅳ组9例;下段癌81例中,Ⅰ组21例,Ⅱ组42例,Ⅲ组18例。全组食管上切端残留癌5例。全组清扫淋巴结8141枚,平均每例(17.85±8.94)枚,检出有淋巴结转移186例,共758枚,淋巴结转移率40.8%(186/456),转移度9.3%(758/8141)。全组发生并发症共80例,其中吻合口瘘12例,胸胃瘘4例,肺部并发症21例。Ⅳ组并发症发生率最高,为36.5%,与其他3组比较差异均有统计学意义。结论胸段食管癌手术径路的个体化选择策略有助于提高肿瘤切除率与根治率。手术创伤的控制是降低术后并发症和提高生存质量的有效手段。Objective To investigate the significance of individualized selection of surgical approaches in thoracic esophageal cancer.Methods From January 2007 to January 2009,456 cases of thoracic esophageal carcinoma patients were treated surgically.The differentiation of tumor radicallity and overall postoperative complications between the different surgical approaches were analyzed.Results All patients were underwent the radical surgery.Left posterior thoracotomy with cervical incision（group Ⅰ） was 268 patients.Single left posterior thoracotomy（group Ⅱ） was 42 cases.Right posterior thoracotomy with upper abdominal incision（group Ⅲ） was 94 cases.Right anterior thoracotomy＋cervical incision＋abdominal incision（group Ⅳ） was 52 cases.Five cases had residual tumor on the cut-end of the esophagus.The overall rate of lymph node metastasis was 40.8%（186/456） and the lymph node metastasis ratio（positive nodes/total dissected nodes） was 9.3%（758/8141）.The highest complication rate was 36.5%（19/52） in group Ⅳ,which was significantly higher than those in other groups.Conclusion The individualized selection strategies of surgical approaches help to increase the radical resection rate.Reduction of surgical trauma may decrease postoperative complications and maintain long-term quality of life.

关 键 词：食管癌 手术径路 淋巴结清扫 

分 类 号：R735.1[医药卫生—肿瘤]