食管胃结合部腺癌患者经胸与经腹食管裂孔手术的疗效比较  

Effects of transthoracic vs transabdominal hiatal approaches for treatment of esophago-gastric junction adenocarcinoma

作　　者：洪澜[1] 郭向东[1] 吕静[1] 汪永寿[2] 李耀东[2] 

机构地区：[1]德阳市人民医院胸外科,四川省德阳市618000 [2]德阳市人民医院消化科,四川省德阳市618000

出　　处：《世界华人消化杂志》2014年第26期3963-3967,共5页World Chinese Journal of Digestology

摘　　要：目的:探究经胸与经腹食管裂孔手术对食管胃结合部腺癌(adenocarcinoma of esophagogastric junction,AEG)患者中SiewertⅡ型和Ⅲ型的效果比较.方法:收集德阳市人民医院收治并进行手术治疗的SiewertⅡ型及Ⅲ型患者共350例,其中胸外科收治148例(经胸组)、普通外科收治202例(经腹食管组).分别由胸外科和普通外科医师对两组患者施行经胸入路手术以及经腹食管裂孔入路手术.由专业医护人员记录两组患者术中以及术后恢复和合并症情况.结果:经腹食管裂孔手术治疗组需进行联合脏器切除的患者数多于经胸手术治疗组(χ2=12.744,P=0.002),而手术时间、术中出血量、食管切除长度以及术中输血患者数均小于经胸手术组(t=3.127、5.719、4.124,χ2=14.435,P=0.039、0.011、0.009、0.000);对两组患者在术后的治疗情况进行比较,经胸手术组的术后疼痛评分以及抗生素应用时间均高于经腹食管裂孔手术组(t=5.879、9.388,P=0.005、0.000),且术后住院时间、住院总费用、再手术及再入院率也高于经腹食管裂孔手术组(t=2.030、2.389,χ2=5.956、7.435,P=0.027、0.021、0.048、0.025);两组患者腹腔感染、吻合口狭窄概率无统计学差异(χ2=1.524、0.149,P=0.217、0.700),而在发生胸肺感染、术后出血以及吻合口漏等方面,经胸手术组均高于经腹食管裂孔手术组(χ2=9.031、4.215、5.075,P=0.003、0.040、0.024).结论:经腹食管裂孔手术方式治疗的SiewertⅡ、Ⅲ型AEG患者术中遭受创伤小、术后恢复快且恢复效果好,合并症发生率低,值得临床上广泛选用.AIM： To compare the effects of transthoracic and transabdominal hiatal approaches for the treat- ment of Siewert types Ⅱ and Ⅲ adenocarcinoma of the esophago-gastric junction. METHODS： A total of 350 patients who were pathologicaIIy diagnosed with Siewert type Ⅱ or type Ⅲ adenocarcinoma of the esophago- gastric junction and underwent surgical treat- ment at our hospital were included, of whom 148 received surgery via the transthoracic ap- proach （transthoracic group） and 202 receivedsurgery via transabdominal hiatal approach （transabdominal hiatal group）. Intraoperative parameters, postoperative recovery and compli- cations were compared between the two groups of patients. RESULTS： The number of patients receiving multi-visceral resection was more in the trans- abdominal hiatal group than in the transthoracic group （2 = 12.744, P = 0.002）, but the operative time, intraoperative blood loss, length of esoph- ageal resection and number of patients receiving transfusion were lower in the transabdominal hiatal group （P = 0.039, 0.011, 0.009, 0.000）. Post- operative pain score and antibiotic use duration in the transthoracic group were significantly higher than those in the transabdominal hiatal group （t = 5.879, 9.388, P = 0.005, 0.000）, and the length of hospital stay, postoperative hospital- ization cost, reoperation, and readmission rate showed the same trend （P =0.027, 0.021, 0.048, 0.025）. Although the rates of abdominal cavity infection and anastomotic stenosis showed no statistical differences between the two groups （2 = 1.524, 0.149, P = 0.217, 0.700）, the rates of lung infection, postoperative bleeding and anas- tomotic leakage were significantly higher in the transthoracic group than in the transabdominal hiatai group （2 = 9.031, 9.031, 4.215, P = 0.003, 0.040, 0.024）.CONCLUSION： Patients with type Ⅱ or Ⅲ ad- enocarcinoma of the esophago-gastric junction treated via the transabdominal hiatal approach suffered from less intraoperative trauma and had quicker

关 键 词：食管胃结合部腺癌 贲门癌 手术路径 

分 类 号：R735[医药卫生—肿瘤]