经胸与经腹食管裂孔手术治疗高龄食管胃结合部腺癌患者的近期效果比较  

Comparison of the short-term efficacy of transthoracic and transabdominal esophageal hiatus surgery for elderly patient with adenocarcinoma of the esophagogastric junction

作　　者：鱼海峰[1] 徐凯[2] 谢宗涛[2] 王志强[2] 王振军[2] 刘传信[2] 

机构地区：[1]江南大学附属医院血管外科,江苏无锡214062 [2]江南大学附属医院胸心外科,江苏无锡214062

出　　处：《消化肿瘤杂志（电子版）》2016年第3期152-155,共4页Journal of Digestive Oncology(Electronic Version)

摘　　要：目的比较经胸与经腹食管裂孔手术治疗高龄食管胃结合部腺癌患者的近期效果。方法回顾性分析2013年8月至2016年2月江南大学附属医院行食管胃结合部癌切除术92例高龄患者临床资料,其中经左胸入路（经胸组）47例,经腹正中入路（经腹组）45例。比较两组患者的一般资料及手术时间、术中出血量、淋巴结清扫数目、术后住院时间及术后并发症的发生率。结果两组患者的手术时间、术中出血量和淋巴结清扫数目无统计学差异（均P≥0.05）。与经胸组相比,经腹组患者获取阳性淋巴结数目更多[（8.1±5.0）枚vs.（5.1±4.4）枚,t=3.000,P=0.003],术后住院时间更短[（11.7±6.9）天vs.（15.9±7.4）天,t=2.773,P=0.007）],术后并发症发生率较低（13.3%vs.44.7%,χ^2=10.895,P=0.001）,其中肺部感染（2.2%vs.14.9%,χ^2=4.649,P=0.031）、心律失常（4.4%vs 19.1%,χ~2=4.722,P=0.030）发生率均较低。两组患者的吻合口瘘、切口感染、纵膈或胸腔感染的发生率均无统计学差异（均P≥0.05）。两组患者均无切缘阳性和围术期死亡病例。结论对于心肺功能差的高龄食管胃结合部腺癌患者,经腹食管裂孔入路比经胸入路手术在对心肺功能影响较小,能够显著降低术后并发症的发生率,缩短住院时间。Objective To compare the short-term efficacy of transthoracic and transabdominal esophageal hiatus surgery for elder patient with adenocarcinoma of the esophagogastric junction（AEG）.Methods Clinical data of 92 elder patients with AEG treated in our hospital from August 2013 to February2016 were analyzed retrospectively. Forty seven patients were received left transthoracic approach（transthoracic group）, and forty five patients were received transabdominal hiatal approach（transabdominal group）. The operation time, blood loss, number of lymph node dissection, time of hospital stay and the incidence of complication were compared between the two groups. Results There were no significant differences in operation time, blood loss and the number of lymph node dissection between the two groups（all P ≥0.05）. Compared with the transthoracic group, transabdominal group had shorter postoperative hospital stay（11.7±6.9 vs. 15.9 ±7.4, t =2.773, P =0.007）, more positive lymph nodes（8.1 ±5.0 vs. 5.1 ±4.4, t=3.000, P=0.003）, less postoperative complications（13.3% vs. 44.7%, χ^~2=11.48, P =0.001）. The incidence of pulmonary infection（2.2% vs. 14.9%, χ^2=4.649, P=0.031） and arrhythmia（4.4% vs.19.1%, χ^2=4.722, P =0.030） were lower in transabdominal group. There were no significant differences in the incidence of anastomotic leakage, wound infection, mediastinal and chest infection（all P ≥0.05）. No positive margin or perioperative death was observed in the two groups. Conclusions For the treatment ofpoor cardiopulmonary function elderly patients with gastroesophageal junction adenocarcinoma,transabdominal hiatal approach causes less impact on cardiopulmonary function and reduces the incidence of perioperative complications, and shorten the hospital stay.

关 键 词：食管胃结合部肿瘤 外科手术 手术入路 肺部感染 心律失常 

分 类 号：R735[医药卫生—肿瘤]