左胸切口与右胸腹联合切口治疗在食管中下段癌根治术中的应用对比分析

摘要

目的 对比左胸切口手术(Sweet术式)与右胸腹联合切口手术(Ivor-Lewis术式)治疗食管中下段癌的效果.方法 选取中下段食管癌并进行手术的患者86例,按照手术方式的不同分为Sweet组(43例)和Ivor-Lewis组(43例),比较两组患者的手术时间、胸腔引流管留置时间、淋巴结清扫数目、住院时间、食管上切缘阳性情况、术后并发症发生率.结果 Sweet组患者的手术时间明显短于Ivor-Lewis组,淋巴结清扫数目明显少于Ivor-Lew-is组(P﹤0.01);两组患者的住院时间、胸腔引流管留置时间比较,差异无统计学意义(P﹥0.05).Sweet组食管切缘阳性以中下段切缘为主,而Ivor-Lewis组以中段切缘为主,差异有统计学意义(P﹤0.05).两组患者术后出现切口感染、吻合口瘘、脓胸、乳糜胸、肺部感染、吻合口出血等并发症,Sweet组并发症总发生率(23.26%)高于Ivor-Lewis组(18.60%),但差异无统计学意义(χ2=0.281,P﹥0.05).结论 左胸切口手术治疗食管中下段癌手术时间短、创伤小,右胸腹联合切口手术病灶视野暴露性较好,淋巴结清扫较彻底,实际操作中应根据患者情况选择适合的手术方式.%Objective To compare the curative effect of left thoracic incision (Sweet) and right thoracoabdominal in-cision (Ivor-Lewis) in the treatment of middle and lower esophageal cancer. Method 86 patients with middle and lower esophageal cancer who had undergone surgery were enrolled and divided into Sweet group (43 cases) and Ivor-Lewis group (43 cases) based on surgery modes;the operation time, retention time of thoracic drainage tubes, number of lymph nodes harvested, length of hospital stay, positive rate of esophagus upper resection margin, and the incidence of postopera-tive complications were compared between two groups. Result The operation time and the number of lymph nodes har-vested in Sweet group were significantly lower than those in Ivor-Lewis group (P<0.01), and there were no significant dif-ferences found in the length of hospital stay and the retention time of thoracic drainage tubes between two groups (P>0.05). The positive resection margins were mainly resection margins of middle and lower part of esophagus in Sweet group and of middle part of esophagus in Ivor-Lewis group, and the differences reached statistical significance (P<0.05). Complications of surgical site infection, anastomotic fistula, empyema, chylothorax, pulmonary infection and anastomotic bleeding were reported in the two groups, the overall incidence of these events in Sweet group (23.26%) was higher than that in Ivor-Lewis group (18.60%), but the difference was not statistically significant (χ2=0.281, P>0.05). Conclusion In the treatment of middle and lower esophageal cancer, the left thoracic incision has the advantage of short operation time and small invasive scope, while right thoracoabdominal incision provides a good visual field for the surgery and a thorough clearance of lymph nodes. The specific surgical method should be chosen according to the actual condition of the patients.