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目的观察右胸腹两切口、食管-胃右胸顶吻合术治疗中、下段食管癌的近远期疗效,探讨其临床应用价值。方法对1999年5月～2002年4月间采用右胸腹两切口治疗中、下段食管癌153例,观察吻合口瘘、吻合口狭窄、切缘阳性、淋巴结清扫情况及术后1、3、5年生存率并进行分析。结果无吻合口瘘、吻合口狭窄发生,吻合口出血2例,清扫淋巴结共计1746个,其中转移淋巴结357个,淋巴结转移率40.5%(62/153),无切缘阳性发生。术后1、3、5年生存率分别为92.1%(140/153)、67.9%(104/153)、49%(76/153)。结论右胸腹两切口具有术野暴露好,吻合确切可靠,肿瘤切除率高,淋巴结清扫彻底,并发症发生率低,不切开膈肌,对呼吸功能影响小等优点,是目前中、下段食管癌较理想的术式。
Objective To observe the short-term and long-term effects of right thoracoabdominal incision and esophageal-right thoracic anastomosis in the treatment of middle and lower esophageal cancer, and to explore its clinical value. Methods From May 1999 to April 2002, 153 cases of middle and lower esophageal cancer were treated with right thoracoabdominal incision. The anastomotic fistula, anastomotic stenosis, positive margins and dissection of lymph nodes were observed. 5-year survival rate and analysis. Results No anastomotic fistula, anastomotic stenosis, anastomotic bleeding in 2 cases, a total of 1746 lymph node dissection, including 357 metastatic lymph nodes, lymph node metastasis rate of 40.5% (62/153), no positive margins. The 1, 3, 5-year survival rates were 92.1% (140/153), 67.9% (104/153) and 49% (76/153) respectively. Conclusion The right thoracolumbar incision possesses the advantages of good operative exposure, consistent and reliable anastomosis, high tumor resection rate, thorough lymphadenectomy, low complication rate, no diaphragmatic incision and low respiratory function, Cancer is the ideal surgical method.