不同术式治疗下段食管癌的疗效观察

目的：探讨经胸及经左胸腹联合行下段食管癌根治术的临床疗效.方法：回顾性分析经胸入路（34例）和经左胸腹联合入路（40例）行下段食管癌根治术患者的临床资料,术中行胸、腹淋巴结清扫,术后行病理组织学检查了解淋巴结转移情况.术后观察2周,比较2组忠者的淋巴结肿瘤转移度、手术时间、术中出血量、围手术期死亡率、并发症发生率、手术住院时间.结果：经胸与经左胸腹联合行下端食管癌根治术比较,手术时间短（2.6 4±0.8）h vs（4.7 4±1.1）h,P〈0.05]、出血量少（418.5 4±112.5）mLvs（693.5.4±124.8）mL,P〈0.05]、围术期并发症发生率低5.9%（2/34）vs 22.5%（9/40）,P〈0.05]、手术住院时间缩短（15.5±4.7）dvs（24.8 4±6.5）d,P〈0.05];2组手术切除淋巴结肿瘤转移度差异无统计学意义（P〉0.05）.结论：经胸行下段食管癌根治术,手术损伤小、恢复快,但远期存活率仍需观察.

Outcomes of lower segment esophageal carcinoma treated with various surgical approaches

Objective： To investigate the outcomes of lower segment esophageal carcinoma treated with transthoracic versus transhiatal radical esophagectomy. Methods：We retrospectively analyzed the clinical data of 34 patients who underwent transthoracic radical esophagectomy （transthoracic group,or group A） and another 40 patients who underwent left transhiatal radical esophagectomy （ transhiatal group, or group B ） for lower esophageal carcinoma. At surgery, the patients received dissection of thoracic and abdominal lymph nodes. Post-operative pathological studies were performed to identify regional lymph node involvement. All patients were under a 2- week observation after operation. Data on lymph node metastasis, operation duration, intraoperative blood loss, perioperative mortality, complications and length of hospital stay between the two groups were compared. Results： Compared with the transhiatal group, the transthoracic group showed shorter operation time （ 2.6 ±0.8 ） b vs （4.7±1.1） b,P〈0. 05],less blood loss（418.5±112.5） mLvs （693.5 ±124.8） mL,P〈0. 05],less perioperative complications 5.9% （ 2/34 ） vs 22.5 % （9/40）, P 〈 0.05 ] and shorter postoperative hospital days （15.5 ＋4.7） d vs （24.8 ± 6.5 ）d, P 〈 0.05 ]. No statistical difference in lymph node metastasis was noted between the both groups （ P 〉0. 05 ）. Conclusion： Transthoracic radical esophagectomy may lead to less operation-related injury and quicker recovery sooner, although the long-term survival rate with this surgical approach is yet to defined.