食管癌手术径路的比较分析

目的：选择一种比较理想的食管癌手术径路，方法：1958年-1997年的40年间945例胸吵段食管癌病例，分为5组，分别采用：（1）左胸后外侧切口食管癌切除，食管胃胸内弓上吻合。（2）右胸前外侧切口加上腹正中切口食管癌切除。胃经食管床胸顶吻合。（3）右胸前外侧切口加上腹正中切口，颈部切口食管癌切除，胃经食管床左颈或右颈吻合。（4）右胸后外侧切口加上腹正中切口，颈部切口食管癌切除，胃经食管床颈部吻合。（5）右胸后外侧切口经胸游高分子食管，食管癌切除，经膈肌食管裂孔游离胃，胸顶食管胃吻合，用SAS医用统计软件列联表方法分析切除率，并发症，死亡率，五年生存率之间的相关性。结果：右胸后外侧切口径路切除率较左胸后外侧切口和右胸前外侧切口径路高，生存率之间也存在明显差异。5组切除率和五年生存率分别为84.19%和29.00%，81.69%和28.57%，83.65%和26.19%，90.74%和34.70%，93.67%和39.74%。结论：右胸后外侧切口径路可作为胸中段食管癌的常规手术径路。

Comparison and analysis of the operation approach of esophageal carcinoma

Purpose:To select a better operation approach for esophageal carcinoma. Methods:From 1958 to 1997, 945 patients of the middle third esophageal carcinoma of our hospital were underwent 5 types of operation.namely: left thoracic approach esophagectomy and esophagogastrostomy; right thoractomy anterolateral and abdomen esophagectomy and esophagogastrostomy; right thoractomy anterolateral and abdomen and cervical approach esophagectomy and esophagogastrostomy; right thoractomy posteriolateral, abdomen and cervical approach esophagectomy and esophagogastrostomy; simple right thoracic approach esophagectomy and esophagogastrostomy. The rate of resectability, rate of complication, rate of mortality and rate of survival of the 5 types of operation were using SAS package and significance test of contingency table. Results:The rate of resectability and the rate of 5 year survival in the five groups were 84.19% and 29.00%, 81.69% and 28.57%,83.65% and 26.19%,90.74% and 34.70%, 93.67% and 39.74%, respectively. Conclusions:Right thoracic approach esophagectomy and esophagogastrostomy are considered superior the operation approach of esophageal carcinoma.