食管中上段癌左右侧开胸两种手术径路疗效的比较  

Comparison of therapeutic efficacy of two kinds of surgical treatment for esophageal carcinoma with left and right thoracotomy

作　　者：赵献军[1] 付升旗[2] 刘恒兴[2] 石力伟[1] 侯建国[1] 方卫红[1] 管福顺[1] 

机构地区：[1]河南省林州市肿瘤医院,林州456500 [2]新乡医学院基础学院,新乡453000

出　　处：《中国肿瘤临床与康复》2016年第1期25-29,共5页Chinese Journal of Clinical Oncology and Rehabilitation

摘　　要：目的比较左、右开胸两种手术径路治疗食管癌的疗效。方法分析2002年1月至2006年1月间收治的4 019例行完全性食管癌切除、食管胃颈部吻合术的食管胸中、上段癌患者资料,根据手术路径分为右开胸(左颈、右胸、腹正中三切口)组(n=1 861)和左开胸(左颈、左胸二切口)组(n=2 158)。对两组患者的手术情况以及围手术期内死亡率和吻合口瘘、喉返神经麻痹、乳糜胸的发生率以及两组患者中相同病理分期(T、N分期)的单一手术患者的生存情况进行比较。结果右开胸组患者临床分期较晚,患者的吻合口瘘(9.6%)、喉返神经麻痹的发生率(9.2%)、院内死亡率(4.6%)高于左开胸组(2.8%、3.2%和1.9%),差异均有统计学意义(P<0.05),但乳糜胸发生率(3.0%)低于左开胸组患者(6.7%,P=0.036)。未行综合治疗的T1、T2、T3患者,则右开胸组的长期生存优于左开胸组(其5年生存率分别为59.1%和42.0%、50.2%和41.0%和44.0%和29.3%,P值分别为0.012、0.036和0.028)。外侵程度分期为T4或转移淋巴结阳性>5时,则两组患者生存率的差异无统计学意义(其5年生存率分别为0和0,P=0.45,0和0,P=0.64)。结论食管胸中、上段癌患者中,只要患者身体条件允许,在肿瘤尚无明显外侵及未出现广泛淋巴结转移时,适宜经左颈、右胸、腹正中三切口进行右开胸手术路径治疗,可以提高患者的远期生存率。Objective To compare the curative effect of two kinds of surgical treatment for esophageal carcinoma with left and right thoracotomy. Methods The data of 4 019 cases with esophageal carcinoma who underwent complete esophageal carcinoma resection and anastomosis of esophagus and stomach and neck between January 2002 to 2006 January from Linzhou Tumor Hospital were analyzed. According to the operation path,the patients were divided into the right thoracotomy group（ three incision： left neck,right chest,abdomen median）（ n = 1 861） and left thoracotomy group（ two incision： left cervical,left chest）（ n = 2 158）. The operation situation and peri-operative mortality and incidence of anastomotic fistula,recurrent laryngeal nerve palsy,chylothorax and the survival of patients with single surgery with the same pathological staging of two groups were compared. Results Clinical stage of right thoracotomy group was later. The incidence of anastomosis fistula and recurrent laryngeal nerve palsy and hospital mortality in right thoracotomy group were higher than that of the left thoracotomy group（ 9. 6% vs 2. 8%,9. 2% vs 3. 2%,4. 6% vs 1. 9%,P values were 0. 012,0. 036,0. 028,respectively）,but postoperative chylothorax incidence rate was lower（ 3. 0% vs 6. 7%,P = 0. 036）. For patients with single surgical treatment,the 5-year survival rates for T1,T2 and T3 were 39. 9%,30. 0% and 21. 5% respectively in right thoracotomy group,while the 5-year survival rates for similarly stagings disease were 27. 8%,23. 0%,7. 4% respectively in left thoracotomy group,and the differences of 5-year survival rates for two group patients with similar staging were significant（ P〈0. 05）. There was no difference in survival rate between two groups in stage T4 or with metastatic lymph nodes more than 5. Conclusions For patiences with middle and upper thoracic esophageal cancer,it is good for treatment with three incision（ the left neck,right chest,abdomen median） surgical approach,which could improve the long-term s

关 键 词：胃肿瘤 食管肿瘤 死亡率 生存率 手术路径 

分 类 号：R735.1[医药卫生—肿瘤]