保留胸肌的微创剖胸切口在早期食管胸中上段癌手术中的应用

目的:初步探讨保留胸肌的微创剖胸切口和经肋骨打孔法关胸在食管胸中上段癌手术应用的可行性.方法:对7例有适应证的患者应用保留胸肌的微创剖胸切口进行右胸、左颈及上腹正中三切口食管癌切除术,总结患者临床资料,分析预后.结果:全组胸部小切口平均长度11 cm .本组无围手术期死亡病例.术后中位留院时间为18天(14～25天).全组患者术后均未出现肩关节活动障碍. 术后1个月首次复查时均达到静息状态下伤口不感疼痛.至随访结束时,7例中5例患者存活,5年生存率71.4%.结论:对于早期食管胸中上段癌患者,应用保留胸肌的微创剖胸切口可能达到满意的远期根治效果,这种术式对减轻术后疼痛、提高生活质量和美观方面也有帮助.

Treatment of early-stage upper and/or middle thoracic esophageal cancer with a new muscle-sparing thoracotomy

Objective: To evaluate the feasibility of performing muscle-sparing thoracotomy and intercostal sutures in the treatment of upper and/or middle thoracic esophageal cancer for the purpose of tumor control and postoperative quality of life improvement.Methods: Seven patients with esophageal cancer were treated with vertical muscle-sparing thoracotomy and Mckeown esophagectomy.Detailed clinic data were summarized and analyzed with patient follow-up information.Results: Of the 7 patients,five were still alive with a 71.4% five-year survival rate.There were no deaths resulting from the operation in this group.The mean length of thoracic incision was 11 cm.The range of hospital stays was 14 to 25 days,with a mean length of 18 days.No patients complained of impaired shoulder action,and the incision pain was hardly perceived without external stimulation 1 month after operation.Conclusion: Performing the muscle-sparing thoracotomy in the treatment of early-stage esophageal cancer located in the upper and /or middle thoracic segment yields a satisfactory long-term survival rate with an improved life quality in terms of incision pain relief and shoulder function.