两种手术方式行中上段食管癌根治的临床研究

目的探讨食管中、上段癌根治术的恰当手术方式,总结几组易发生癌转移淋巴结的转移情况。方法回顾性分析我院行食管癌根治术的538例患者的临床资料,比较两种手术路径并发症发生率和淋巴结清除的情况。结果术式Ⅱ在呼吸衰竭的发生率、喉返神经损伤的发生率、平均胸引液量均明显高于术式Ⅰ,差异有统计学意义(P<0.01);而在死亡率、胸胃吻合口瘘、心律失常方面差异无显著性(P>0.05)。几组重要部位淋巴结转移情况如下:右喉返神经旁淋巴结(2R)转移率16.2%(30/187),转移度23.1%(36/150);前纵膈淋巴结(6组)转移率8.1%(28/351),转移度6.5%(18/276);主肺动脉窗淋巴结组(5组)转移率6.7%(59/351),转移度20.7%(60/289)。腹腔淋巴结转移率3.9%(21/538),转移度2%(35/1780)。结论术式Ⅱ清扫范围大于术式Ⅰ,但都有难以清除而又易发生癌转移的淋巴结组。且术式Ⅱ并发症发生率高于术式Ⅰ组。对年龄大,病变早,有慢性咳嗽病史者应考虑用术式Ⅰ,但对病变较晚、较长、分化程度低、身体较好的患者应用术式Ⅱ。

Clinical research of two surgical methods for radical esophagectomy

Objective To compare advantages and disadvantages of the left common carotid, left thoracotomy （sur- gery type Ⅰ） with the left common carotid, right thoraeotomy, abdominal approach （surgery type Ⅱ） for radical esophage- ctomy, to investigate the appropriate surgical approach. Methods The retrospective analysis of clinical data of our hospi- tal from February 2006 to December 2011 of radical esophagectomy were analyzed. The incidence of complications and lymph node dissection of the surgical approach were observed. Results The incidence of respiratory failure, the incidence of recurrent laryngeal nerve injury and the average chest cited fluid of surgery type I were significantly higher than that of surgery type Ⅱ （P〈0.01）, while consistent in terms of mortality, chest, stomachfistula, arrhythmia aspect was no sig- nificant difference. The right recurrent laryngeal nerve lymph nodes （2R） transfer rate was 16.2% （30/187） and the transfer degree was 23.1% （36/150）. The anterior mediastinal lymph nodes （6） transfer rate was 8. 1%（28/351） and the transfer degree was 6.5% （18/276）. The main pulmonary window lymph node （5） transfer rate was 6.7% （59/351） and the transfer degree was 20. 7% （60/289）. Abdominal lymph node metastasis rate was 3.9% （21/538） and the trans- fer degree was 2% （35/1780）. Conclusion Surgical Ⅱ lymph node dissection was better than surgical Ⅰ , but both have difficult in removing the lymph node groups that are prone to metastasis. Surgery type Ⅰ should be selected for patients who are senior citizens or have early lesions or have chronic cough history.