不同手术路径治疗胸中段食管癌的疗效分析

目的：探讨经左胸后外侧路径手术和Ivor-Lewis手术治疗胸中段食管癌的疗效。方法选择210例胸中段食管癌患者，根据手术路径的不同分为左胸切口组（75例）和Ivor-Lewis组（135例），比较两组患者的淋巴结清扫数、手术时间、术中出血量、术后胸腔引流量、住院天数、术后并发症等。结果 Ivor-Lewis组淋巴结阳性率为（4.99±1.08）%，与左胸切口组的（5.24±1.21）%比较，差异无统计学意义（P﹥0.05）。左胸切口组手术时间和住院天数短于Ivor-Lewis组，差异有统计学意义（P﹤0.05）；且术中出血量少于Ivor-Lewis组，差异有统计学意义（P﹤0.05）。Ivor-Lewis组术后并发症总发生率为22.96%，与左胸切口组（20.00%）比较，差异无统计学意义（P﹥0.05)。结论两种手术方法各有优点和弊端，临床工作中应综合考虑肿瘤的大小、位置、扩散程度及患者的承受能力，决定最佳手术入路。

Clinical effect of left posterolateral thoracic approach and Ivor-Lewis esoph-agectomy in patients with middle thoracic esophageal carcinoma

Objective To investigate the clinical effect of left posterolateral thoracic approach and Ivor-Lewis esopha-gectomy in the treatment for patients with middle thoracic esophageal carcinoma. Method 210 cases of middle thoracic esophageal carcinoma were included in the study, and were stratified as left posterolateral thoracic approach (LPTA) group (n=75) or Ivor-Lewis group (n=135) as per respective surgical approach. The number of dissected lymph nodes, op-erative time, intraoperative blood loss, postoperative chest drainage, hospital stay and incidence of complications of the two groups were compared. Result The positive rate of lymph node in Ivor-Lewis group was similar with the LPTA group [(4.99±1.08)%vs (5.24±1.21)%, P>0.05];While the operative time and hospital stay were significantly less in LP-TA group than that of Ivor-Lewis group (P<0.05), and less intraoperative blood loss was observed in LPTA group (P<0.05);There was no significant difference between the incidences of complications of Ivor-Lewis group (22.96%) and LP-TA group (20.00%) (P>0.05). Conclusion The two surgical procedures are of their own advantages and disadvantages, the optimum choice should be made based upon the tumor size, position, metastasis and patient’s economic capacity in the clinical practice.