两种手术径路治疗胸中段食管鳞癌的对比分析

发布时间：2018-05-13 19:34

本文选题：胸中段食管癌 + 手术入路　；参考：《山东大学》2015年硕士论文

【摘要】：研究背景：在中国最常见的食管恶性肿瘤是食管鳞状细胞癌,食管的胸中段是食管鳞癌的好发部位,对于早、中期食管鳞状细胞癌的首选治疗方式仍是手术治疗。目前国内治疗胸中段食管鳞癌最常用的两种手术路径为经左胸入路和经右胸入路。其中经左胸入路根据吻合部位的不同分为经左胸的食管癌切除、胃食管左颈部吻合术和经左胸的食管癌切除、主动脉弓上胃食管吻合术；根据右胸入路吻合部位的不同分为右后外侧切口开胸+腹部正中开腹(Ivor-Lewis术)和颈胸腹联合三切口食管癌切除术。目的：比较右胸、上腹部、左颈部三切口和左胸、颈部两切口入路治疗胸中段食管鳞癌的围手术期并发症及疗效差异。方法：选取我院自2006年12月至2008年12月收治的97例食管癌手术患者,术前及术后病理均证实为鳞状细胞癌,其中55例经右胸入路(观察组),42例经左胸入路(对照组),回顾性分析这两种径路的术后引流量、手术并发症、淋巴结清扫情况及生存率并进行统计学分析。结果：右胸组术后因吻合口瘘及呼吸功能衰竭死亡2例,左胸组无死亡病例；右胸组并发症与左胸组并发症发生率大多无显著差异,但右胸组肺部感染、心律失常发生率差异有显著性(P0.05)；观察组清扫淋巴结990个,阳性率23.8%,对照组清扫淋巴结504个,阳性率12.4%(P0.05)；右胸组5年生存率(45.5%)高于左胸组5年生存率(21.4%)(P0.05)；观察组手术时间及术中失血量与对照组相比差异有显著性(P0.05),术后第1天引流量无显著差异。结论：对于一般情况良好,并且又无法确定上纵膈及颈部有无淋巴结转移的食管癌患者,有选择性的行右胸三切口手术是一个比较好的方式。
[Abstract]:Background: the most common esophageal malignant tumor in China is squamous cell carcinoma of the esophagus, the middle part of the esophagus is the predilection site of esophageal squamous cell carcinoma. Surgical treatment is still the first choice for early and middle stage esophageal squamous cell carcinoma. At present, the two most common surgical approaches for middle thoracic esophageal squamous cell carcinoma in China are left thoracic approach and right thoracic approach. According to the site of anastomosis, the transthoracic approach was divided into three groups: esophagectomy via left chest, gastroesophagoesophagostomy by left neck anastomosis, esophagectomy via left thoracic esophagectomy, and gastroesophageal anastomosis by upper aortic arch. According to the anastomosis site of the right thoracic approach, we divided the right posterolateral incision into right posterolateral incision and Ivor-Lewis thoracostomy (median thoracotomy) and combined cervical, thoracoabdominal and three-incision esophagectomy. Objective: to compare the perioperative complications and curative effect of right chest, upper abdomen, left neck three incisions and left chest and neck incision in the treatment of middle thoracic esophageal squamous cell carcinoma. Methods: from December 2006 to December 2008, 97 patients with esophageal carcinoma were selected and proved to be squamous cell carcinoma (SCC) before and after operation. Among them, 55 cases underwent right thoracic approach (observation group 42 cases underwent left thoracic approach (control group), the drainage, complications, lymph node dissection and survival rate of the two approaches were analyzed and statistically analyzed. Results: two cases died of anastomotic fistula and respiratory failure after operation in the right chest group, but no death occurred in the left chest group, but there was no significant difference in the incidence of complications between the right thoracic group and the left thoracic group, but pulmonary infection was found in the right chest group. The incidence of arrhythmia was significantly different between the observation group and the control group, 990 lymph nodes were dissected and the positive rate was 23.8in the observation group, 504 lymph nodes were dissected in the control group. The 5-year survival rate in the right chest group was higher than that in the left chest group (P 0.05), the operative time and blood loss in the observation group were significantly different from those in the control group, and there was no significant difference in drainage flow on the first day after operation. Conclusion: for the patients with esophageal carcinoma who are in good condition and can not determine whether the upper mediastinum and neck have lymph node metastasis, the selective triple incision of right chest is a better method.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R735.1

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