胸段食管癌切除三切口径路与左胸径路的对比分析  

Esophagectomy in cancer of thoracic esophagus : comparison of 3-phase approach and left-thoracic approach

作　　者：陈勇[1] 李国富[1] 刘玉祥[1] 姜绪平[1] 蔡忠兵[1] 倪元峰[1] 

机构地区：[1]武警上海总队医院外一科,上海201103

出　　处：《武警医学》2003年第12期724-726,共3页Medical Journal of the Chinese People's Armed Police Force

摘　　要：目的 为了评价三切口及左胸两种术式治疗胸段食管癌的疗效及合理性。方法 对1990年1月-2001年8月11年间我院收治的151例经颈、胸、腹三切口径路和118例经左胸径路手术的胸段食管癌病例的临床资料进行回顾性对比分析。结果 三切口组的手术切除率、平均手术时间、平均手术出血量与左胸组无统计学差异;三切口组平均食管切除长度平均清扫淋巴结数目明显优于左胸组,两组比较有显著差异(P<0.05)。三切口组吻合口瘘及喉返神经损伤发生率稍高但不增加手术病死率;左胸组食管切端阳性率高,吻合口瘘的病死率高。两组的术后1～3年生存率比较无统计学差异,但5 a生存率三切口组高于左胸组,两组比较有显著差异(P<0.05)。结论 三切口术式治疗胸段食管癌更符合肿瘤治疗原则,更安全,疗效更好,术式相对合理。Objective To evaluate the advantages of these two types of esophagectomy and select a reasonable operative mode for the cancer of thoracic esophagus. Methods From January 1990 to August 2001, 269 patients with career of thoracic esophagus underwent esophagectomy, of whom 151 were operated on via cervical, right thoracic and abdominal approach (3-phase approach), and 118 via left thoracic approach. All data of these patients were analyzed and compared. Results In 3-phase group, the resectability rate was 97.4% , the average duration of operation was (247.3±82.5) min.and the average operative blood loss was (470.5± 120.5) ml; in left thoracic group,the data were 93.2%, (225.0 ±54.5) min.and (410.2 ± 125.5) ml, respectively ( P > 0.05) .In 3-phase group, the average length of esophagus dissected was (20.3 ±3.6) cm,and the average number of lymph nodes dissected was 17.6 ±8.8;in left thoracic group, these data were (15.9±8.8) cm,and 8.9±7.2,respectively ( P <0.05).In 3-phase group,the 1 and 3 year survived rates were 84.3% and 67.1% respectively; in left thoracic group, they were 77.1% and 59.5% .respectively ( P > 0.05), The 5-year survival rates were 42.5% for 3-phase group, and 24.6 % for left thoracic group( P < 0.05). Conclutions The esophagectomy via 3-phase approach is a safe, rational, and superior surgical procedure for treating the cancer of thoracic esophagus.

关 键 词：食管癌 食管癌切除术 食管胃吻合术 喉返神经损伤 吻合口瘘 术中出血 

分 类 号：R735.1[医药卫生—肿瘤]