不同术式治疗食管中下段癌的临床研究

摘要

目的 比较不同术式治疗食管中下段在手术创伤、恢复和淋巴结清扫方面的差异.方法 59例食管中下段癌病人接受食管癌切除手术.根据手术入路的不同,被分为3组:右胸、腹两切口手术组(两切组),右胸、腹、左颈三切口手术组(三切组)及左胸入路手术组(左胸组).收集临床数据并进行统计学分析.结果 手术切除率100%,无围手术期死亡.两切组、三切组和左胸组在术后住院时间、术后全身炎症反应综合征时间、体液丢失总量方面差异无统计学意义(P=0.287、0.641和0.355).3组的淋巴结清扫中位总数分别为22.5(11-39)枚、26(14-56)枚和17(7-44)枚(P=0.005);腹腔淋巴结清扫总数分别为10(5-26)枚、12(4-31)枚和8(3-19)枚(P=0.021).胸腔淋巴结清扫数目3组之间差异无统计学意义(P=0.177).食管中、下段癌淋巴结最常转移部位依次为贲门周、中段食管旁、胃左动脉旁等.经右胸食管癌手术的淋巴结清扫范围更广.结论 在创伤和整体恢复方面,左胸手术和右胸手术之间没有显著差异,而右胸手术组淋巴结清扫总数更多.由于食管中下段癌的淋巴结转移范围广泛,应该进行更认真、彻底的淋巴结清扫工作,以期降低局部复发率并改善生活质量.%Objective Surgical approech differs between China and western countries in the treatment of middle/lower aegment thoracic esophageal cancer. This study was designed to compare the effects of different surgical modalities on traumatic reaction, heal-ing process and lymph node dissection.Methods Fifty-nine petients,diagnosed with middle/lower segment of thoracic esophageal cancer, were enlisted and had undergone curative RO esophagectomy.The patients were categorized based on different approaches as the following three groups:group of Ivor-Lewis operation,group of McKeown operation and group of esophagectomy through left tran-sthoracic approach.Clinical data was summarized and malyzed.Results (1)No surgical death was reported in this study.(2)There were no statistical difference among the three groups in tenms of postoperative hospital stay,diration of systemic inflammatory re-sponse syndrome and total body fluid loes (P=0.287,0.641,0.355).(3) The number of total lymph nodes harvested from the above three groups was 22.5(11-39),26(14-56).and 17(7-44)(P=0.005),respectively.The number of abdominal lymph nodes harvested from the above three groups was 10(5-26),12(4-32),and 8(3-19)(P=0.021),respectively.No statistical difference was found to the number of thoracic lymph nodes among three groups.(4)Lymph node metastasis occurred most frequently in the station of pericardial lymph nodes,followed by middle thoracic paraesophageal nodes along the left gastric ar-tery.The range of metastasized lymph nodes dissected through left transthoracic approach was much limited compated with right tran-sthoracic approach.Conchuslon The was no difference between left and right transthoracic approach in terms of surgical trauma and overall rehabilitation.The number of lymph nodes harvested from right transthoracic approach surpassed that from the left approach, which might be due to the extent of abdoominal lymphadenectomy.Considering wide range of lymph node metastasis,We recommedn a more extended lymph node dissection for middle/lower segment of thoracic esophageal cancer for the purpose of better local control control and survival benefit.