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目的比较经胸、经左胸腹行下段食管癌根治手术的优缺点,探讨淋巴结清扫的最佳手术径路。方法回顾性分析2000年1月至2005年1月中山大学附属第一医院心胸外科经胸(96例)和胃肠外科经左胸腹入路(117例)行下段食管癌根治术的临床资料,比较二组的胸、腹淋巴结清扫数、各区域淋巴结转移度、手术时间、出血量、围手术期死亡率、术后并发症发生率、术后平均恢复时间、生存率。结果经左胸腹组和经胸组在上纵隔及No.1、2、3、4和No.7、8、9、11的淋巴结转移度比较,二组差异有统计学意义(P<0.05);围手术期死亡率、手术时间、出血量、并发症发生率、术后平均恢复时间、生存率,二组比较差异均无统计学意义(P>0.05)。结论下段食管癌根治术经胸入路对上纵隔淋巴结清扫有优势,而经左胸腹入路对腹腔淋巴结清扫有优势。
Objective To compare the advantages and disadvantages of transthoracic surgery, radical surgery of lower esophageal carcinoma in the lower thoracic and abdominal region, and explore the best surgical approach for lymphadenectomy. Methods From January 2000 to January 2005, the clinical data of the lower esophageal cancer radical mastectomy in the lower thoracotomy (117 cases) underwent thoracotomy (96 cases) and gastrointestinal surgery in the First Affiliated Hospital of Sun Yat-sen University from January 2000 to January 2005 were retrospectively analyzed. The thoracic and abdominal lymph node dissection number, regional lymph node metastasis, operation time, blood loss, perioperative mortality, postoperative complications, postoperative average recovery time and survival rate were compared between the two groups. Results There was significant difference in the degree of lymph node metastasis between the left thoracic and transthoracic groups in the mediastinum and No.1, 2, 3, 4 and No.7, 8, 9 and 11 (P <0.05 ). There was no significant difference in perioperative mortality, operation time, blood loss, complication rate, average postoperative recovery time and survival rate between the two groups (P> 0.05). Conclusions The lower esophageal cancer radical operation by transthoracic approach is superior to the superior mediastinum lymph node dissection, while the left thoracic abdominal approach has the advantage of peritoneal lymph node dissection.