胸段食管癌手术径路的个体化选择

目的　探讨胸段食管癌手术径路选择个体化的意义。方法　回顾性研究２００７年１月至２００９年１月共４５６例胸段食管癌根治患者的临床资料，分析不同手术径路对肿瘤根治性与术后并发症的影响。结果　全部患者均顺利完成食管癌根治术，其中左胸后外侧开胸＋左颈部切口（Ⅰ组）２６８例，单纯左胸后外侧开胸（Ⅱ组）４２例，右胸后外侧开胸＋上腹部正中切口（Ⅲ组）９４例，右胸前外侧开胸＋上腹部正中切口＋颈部切口（Ⅳ组）５２例。胸上段癌５９例中，Ⅳ组４３例，Ⅰ组１６例（临床分期Ｔ_１-２Ｎ_０Ｍ_０）；中段癌３１６例中，Ⅰ组２３１例，Ⅲ组７６例，Ⅳ组９例；下段癌８１例中，Ⅰ组２１例，Ⅱ组４２例，Ⅲ组１８例。全组食管上切端残留癌５例。全组清扫淋巴结８１４１枚，平均每例（１７.８５±８.９４）枚，检出有淋巴结转移１８６例，共７５８枚，淋巴结转移率４０.８％（１８６／４５６），转移度９.３％（７５８／８１４１）。全组发生并发症共８０例，其中吻合口瘘１２例，胸胃瘘４例，肺部并发症２１例。Ⅳ组并发症发生率最高，为３６.５％，与其他３组比较差异均有统计学意义。结论　胸段食管癌手术径路的个体化选择策略有助于提高肿瘤切除率与根治率。手术创伤的控制是降低术后并发症和提高生存质量的有效手段。

Individualized selection of the operative approaches to thoracic esophageal carcinoma

Objective To investigate the significance of individualized selection of surgical approaches in thoracic esophageal cancer.Methods From January 2007 to January 2009,456 cases of thoracic esophageal carcinoma patients were treated surgically.The differentiation of tumor radicallity and overall postoperative complications between the different surgical approaches were analyzed.Results All patients were underwent the radical surgery.Left posterior thoracotomy with cervical incision（group Ⅰ） was 268 patients.Single left posterior thoracotomy（group Ⅱ） was 42 cases.Right posterior thoracotomy with upper abdominal incision（group Ⅲ） was 94 cases.Right anterior thoracotomy＋cervical incision＋abdominal incision（group Ⅳ） was 52 cases.Five cases had residual tumor on the cut-end of the esophagus.The overall rate of lymph node metastasis was 40.8%（186/456） and the lymph node metastasis ratio（positive nodes/total dissected nodes） was 9.3%（758/8141）.The highest complication rate was 36.5%（19/52） in group Ⅳ,which was significantly higher than those in other groups.Conclusion The individualized selection strategies of surgical approaches help to increase the radical resection rate.Reduction of surgical trauma may decrease postoperative complications and maintain long-term quality of life.