经上腹、右胸联合切口手术治疗中段食管癌的疗效观察

【目的】探讨采用上腹、右胸联合切口根治性切除中段食管癌的临床效果。【方法12005年8月至2009年12月闻本院收治中段食管癌（肿瘤上缘距门齿约24～27cm）患者156例，按手术路径分为两组：右胸组采用上腹、右胸联合切口进行食道癌根治手术，左胸组采用经左胸路径切口进行食道癌根治手术。观察比较两组手术切除率、术后吻合口漏、吻合口狭窄、切缘阳性率等情况。【结果】右胸组患者术后吻合口漏发生率、切缘阳性率均较经左胸组患者低，且差异有统计学意义（P〈0．05）。【结论】选择经上腹、右胸二切口根治性手术治疗中段食管癌，特别对病变侵及主动脉弓及气管隆凸者，可以减少并发症及提高根治效果。

Efficacy of Double Incisions for the Treatment of Patients with Middle Esophageal Carcinoma

Objective] To investigate the clinical efficacy of radical resection by right thoracal and upper abdominal double incisions for the treatment of middle esophageal carcinoma. Methods] Totally 156 cases of middle esophageal carcinoma which the distance between the superior margin of carcinoma and incisor teeth was 24-27cm were treated in our hospital from Aug. 2005 to Dec. 2009. According to surgical approach, all patients were divided into two groups. Right thorax group underwent radical resection of esophageal carcinoma by right thoraeal and upper abdominal double incisions, and left thorax group underwent radical resection of e sophageal carcinoma by left thoracal incision. The resection rate, postoperative anastomotic leakage and steno- sis and the positive rate of cutting edge were observed and compared. Results] The incidence of postoperative anastomotic leakage and the positive rate of cutting edge in right thorax group were lower than those in left thorax group, and there was significant difference（ P〈0.05）. Conclusion] The radical resection by right thoracal and upper abdominal double incisions for the treatment of middle esophageal carcinoma can reduce the complications and improve the radical cure effect, especially for patients with invasion of aortic arch or carina.