不同切口开胸食管癌根治术对高海拔地区患者肺功能的影响

摘要

Objective:To explore the influence of open thoracic esophageal cancer radical surgery through different incisions on pulmonary function in high altitude area.Methods:All 218 patients with esophageal cancer treated in our hospital from January 2004 to June 2010 were selected as the subjects and divided into two groups according to the surgical incision.The 108 patients of the control group received trans -left -posterior -lateral incision open thoracic esophageal cancer radical surgery and the 110 patients of the observation group received trans -right -anterior -lat-eral incision open thoracic esophageal cancer radical surgery.Operation time,intra operative pleural open time,single lung ventilation time of two groups were compared and their pulmonary function were tested before operation,1 month and 3 months after operation.Results:There was no statistical difference on operation time,preoperative pulmonary function between two groups(P >0.05).Pleural open time,intra operative single lung ventilation time of observation group was less than that of control group(P <0.05).Pulmonary function after operation both showed injury in two groups.Yet observation group's index was slight(P <0.05).Conclusion:Radical mastectomy of right anterolateral in-cision reduces intraope rative pleural open time and single lung ventilation time,also avoids diaphragm injury,and less influence on pulmonary function in esophageal cancer patients when com pared with left posterolateral incision,so it is more conducive to patients'post operative pulmonary function recovery.%目的：探讨右前外侧与左后外侧切口开胸食管癌根治术对高海拔地区食管癌患者肺功能的影响。方法：回顾性分析2004年1月－2010年6月在我院行手术治疗的218例食管癌患者的临床资料（术后无严重并发症，患者来自高海拔地区）。其中108例食管癌患者行左后外侧开胸手术，设为对照组；其余110例经右前外侧开胸行颈部吻合，设为观察组。比较两组患者的手术时间、胸腔开放时间、术中单肺通气时间，分别于术前、术后1个月、术后3个月检测患者的肺功能。结果：两组患者手术时间、术前肺功能指标比较，差异无统计学意义（P ＞0．05）。观察组胸腔开放时间、术中单肺通气时间均少于对照组，差异有统计学意义（P ＜0．05）。术后两组患者的肺功能指标均呈损伤表现，但观察组较对照组轻微，差异有统计学意义（P ＜0．05）。结论：右前外侧切口开胸行食管癌根治术可缩短术中胸腔开放时间和术中单肺通气时间，避免损伤膈肌，因而较左后外侧切口入路对患者肺功能的影响更小，有利于术后患者肺功能的恢复。