不同手术方式对胸中段食管癌的近期和远期疗效评估

目的探讨不同手术方式对胸中段食管癌的近期和远期疗效。方法回顾性分析本院收治的182例食管癌手术患者的I临床资料，其中行Ivor—Lewis术（A术）患者131例，行经左胸食管大部切除、主动脉弓上食管胃吻合术（B术，弓上食管胃吻合术）患者51例。对2组患者吻合口瘘、肺部感染等手术并发症进行统计，观察2组患者5年生存率、5年肿瘤复发率，分析患者年龄、性别、手术方法、术后并发症、肿瘤分期和淋巴结转移与食管癌患者的预后关系。结果A术发生吻合口或胃瘘、吻合口狭窄、喉返神经损伤、乳糜胸、肺部感染、胃扩张、幽门或胃梗阻的概率与B术相比无显著差异（P〉0．05）；两种手术方式总的并发症发生率比较也无显著差异（χ2=1．927，P=0．165）；A术术后5年的生存率为36．64％，而B术术后5年生存率为35．29％，两种术式比较差异无统计学意义（χ2=0．082，P=0．77）；A术术后5年肿瘤复发率为71％，而B术术后5年肿瘤复发率为76．47％，差异无统计学意义（χ2=0．41，P=0．52）；Cox回归分析结果发现，肿瘤的分期及淋巴结转移与患者的预后密切相关（P=0．005和P=0．027），而与年龄、性别、病变长度、手术方法和术后并发症无显著相关性（P〉0．05）。结论Ivor—Lewis术与经左胸食管大部切除、主动脉弓上食管胃吻合术两种手术方式并不是中段食管癌的预后危险因素，应根据患者的具体情况选择手术方式。

Effects of short - term and long - term evaluation of different operation methods on the middle thoracic esophageal carcinoma

Objective To compare and evaluate the therapeutic efficacy of two different sur- gical approaches to treat middle thoracic esophageal squamous cell carcinoma. Methods One hundred and eighty - two patients with middle thoracic esophageal squamous cell carcinoma, including 1 31 who underwent Ivor - Lewis esophagectomy and another 51 who underwent one incision esophagectomy through left thoracic and upper arotic arch approach were reviewed. The survival rate and the prognos- tic risk factors were assessed. Results There was no significant statistical difference between Ivor - Lewis esophagectomy and one incision esophagectomy through left thoracic and upper arotic arch ap- proach （ P 〉 0.05 ）. No significant statistical difference of the 5 - year survival rate and recurrence rate were observed between two groups （P = 0.77 and P = 0.52）. In Cox regression analysis, T clas- sification （ P = 0. 027 ） and N classification （ P = 0. 005 ） were the independent prognostic risk factors. Conclusion Ivor - Lewis esophagectomy and one incision esophageetomy through left thoracic and up- per arotic arch approach are both feasible options to treat middle thoracic esophageal squmamous cell carcinoma. Patient＇s individual condition is suggested to be taken into account when choosing the oper- ative approaches.