不同入路治疗老年食管胃结合部癌的临床对比研究

目的:探讨经胸与经腹入路食管癌根治术治疗老年食管胃结合部癌的临床疗效及安全性。方法:选取2012年4月至2014年4月收治的130例老年食管胃结合部癌患者,以随机数字表法分为经胸组(n=65)与经腹组(n=65),分别经胸与经腹入路完成食管癌根治手术。比较两组手术相关临床指标、术后并发症发生率及随访生存率。结果:两组手术时间、手术出血量及淋巴结检出数量差异无统计学意义(P0.05);经腹组淋巴结检出转移阳性数量、总住院时间均优于经胸组(P0.05);两组切口感染、纵隔感染及吻合口瘘发生率差异无统计学意义(P0.05);经腹组肺部感染、心律失常发生率低于经胸组(P0.05);经腹组术后1年、2年及3年生存率高于经胸组(P0.05)。结论:相较经胸入路,经腹入路根治手术治疗老年食管胃结合部癌可提高转移淋巴结检出数量,缩短住院时间,延长远期生存时间,并有助于避免肺部感染与心律失常的发生。

Clinical comparative study of different kinds of radical surgical approaches in the treatment of elderly patients with gastroe-sophageal junction cancer

Objective:To investigate the clinical effects and safety of radical surgery by transthoracic approach and transabdom-inal approach in the treatment of elderly patients with gastroesophageal junction cancer. Methods:One hundred and thirty elderly pa-tients with gastroesophageal junction cancer were chosen from Apr. 2012 to Apr. 2014 and randomly divided into transthoracic group (65 patients) and transabdominal group (65 patients). The operation-related clinical index,complications incidence and survival rate of both groups were compared. Results:There was no significant difference in the operation time,the amount of blood loss and the number of lymph node detected between 2 groups (P>0. 05). The number of positive lymph node detected and the total hospitalization time of transabdominal group were significantly better than those of transthoracic group (P<0. 05). There was no significant difference in the incidence of incision infection,mediastinal infection and anastomotic fistula between 2 groups (P>0. 05). The incidence of lung infec-tion and arrhythmia of transabdominal group were significantly lower than those of transthoracic group (P<0. 05). The survival rate in 1,2 and 3 years after operation of transabdominal group were significantly higher than those of transthoracic group (P<0. 05). Conclu-sions:Compared with transthoracic approach,transabdominal radical surgery in the treatment of elderly patients with gastroesophageal junction cancer can efficiently increase the number of positive lymph nodes detected,shorten the hospitalization time,prolong the long-term survival time and can be helpful to avoid the risk of lung infection and arrhythmia.