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目的:探讨全胸段食管切除与胸中下段食管切除对食管癌患者术后生存率的影响,确定食管癌根治术的最佳手术入路,提高患者手术后长期生存率。方法:我院胸外科1999年1月~2001年12月对193例胸下段食管癌患者,行左胸后外侧切口(Ⅰ组)67例,行左胸后外侧切口+左颈切口(Ⅱ组)65例,行三切口(Ⅲ组)155例,完成食管癌食管切除术、经食管床食管重建术。结果:Ⅰ组患者术后1、3和5年生存率分别为77·14%、78·43%和82·54%,Ⅱ组分别为62·62%、58·36%和61·09%,Ⅲ组分别为38·12%、39·32%和42·07%。三组患者术后1、3年生存率差异无统计学意义,P>0·05。Ⅰ、Ⅲ组间5年生存率差异有统计学意义,P<0·05。Ⅰ、Ⅱ组间及Ⅱ、Ⅲ间5年生存率差异无统计学意义,P>0·05。结论:胸下段食管癌病例采取三切口的手术入路,5年生存率高于左胸后外侧切口组,且与左胸+左颈二切口相比,长期生存率显示增高的趋势。对于胸下段食管癌病例,应选择三切口手术入路。
Objective: To investigate the effect of total thoracic esophagectomy and lower thoracic esophagectomy on the postoperative survival rate of patients with esophageal cancer, to determine the best surgical approach for esophageal cancer radical operation and to improve the long-term survival rate after operation. Methods: From January 1999 to December 2001, 193 patients with thoracic esophageal cancer underwent thoracotomy (group Ⅰ), 67 patients underwent left lateral thoracotomy + left cervical incision (group Ⅱ) ) 65 cases, three incisions (Ⅲ group) 155 cases, complete esophagectomy esophageal cancer, transesophageal esophageal reconstruction. Results: The 1, 3 and 5 year survival rates of patients in group Ⅰ were 77.14%, 78.43% and 82.54% respectively, while those in group Ⅱ were 62.62%, 58.36% and 61.09%, respectively , And those in group Ⅲ were 38.12%, 39.32% and 42.07% respectively. There was no significant difference in one and three-year survival rate between the three groups after operation (P> 0.05). The 5-year survival rates of group Ⅰ and group Ⅲ were significantly different (P <0.05). There was no significant difference in the 5-year survival rates between Ⅰ, Ⅱ and Ⅱ, Ⅲ, P> 0.05. CONCLUSION: Three-incision surgical approach is adopted in the lower thoracic esophageal cancer patients. The 5-year survival rate is higher than that of the left thoracotomy group, and the long-term survival rate is higher than that of the left thoracic + left cervical incision. For lower thoracic esophageal cancer cases, should choose three incision surgical approach.