目的 探究左右胸两种手术入路治疗胸中段食管鳞癌的临床效果.方法 选取四川省人民医院2011年5月～2013年5月收治的90例胸中段食管鳞癌患者,按照入路方式的不同,分为左胸组与右胸组,每组各45例,左胸组于左胸后外侧做手术切口入路,右胸组则于腹正中小切口做手术入路,对比两组手术时间、术中出血量、清扫淋巴结个数、术后首日胸腔引流量、术后总引流时间、淋巴结转移个数、并发症发生率及随访3年复发率及生存率.结果 右胸组的手术时间长于左胸组,清扫淋巴结个数多于左胸组,差异有统计学意义(P＜0.05).两组的术中出血量、术后首日胸腔引流量、术后总引流时间、淋巴结转移个数比较,差异无统计学意义(P＞0.05).两组的吻合口瘘、肺部感染、呼吸衰竭、切口感染发生率比较,差异无统计学意义(P＞0.05).右胸组心房颤动发生率明显低于左胸组,差异有统计学意义(P＜0.05).随访3年期间,两组总生存率及复发率比较,差异无统计学意义(P＞0.05).结论 左右胸入路均可作为治疗胸中段食管鳞癌的可选路径,但右胸入路的清扫淋巴结更彻底.%Objective To explore clinical effect of two kinds of left and right thoracic surgical approach in the treatment of mid-thoracic esophageal squamous carcinoma.Methods 90 patients with mid-thoracic esophageal squamous carcinoma in People's Hospital of Sichuan Province from May 2011 to May 2013 were selected and divided into left thoracic group and right thoracic group according to the road way different,45 cases in each group.Then left thoracic group was with incision approach by chleft thoracic surgery,right thoracic group was with incision approach by abdominal small incision.The operation time,intraoperative blood loss,resection in patients with lymph node number on the first day,postoperative chest total flow rate,postoperative drainage time,the number of lymph node metastasis,complication and recurrence rate and survival rate followed up in 3 years between two groups were compared.Results The operation time of right thoracic group was longer than that of left thoracic group,the number of dissected lymph nodes in right thoracic group was higher than that in left thoracic group,with statistical differences (P ＜ 0.05).The intraoperative blood loss,postoperative chest on the total flow rate,postoperative drainage time,the number of lymph node metastasis of two groups had no statistical difference (P ＞ 0.05).The anastomotic fistula rates,pulmonary infection rate,respiratory failure rate and incision infection rate of two groups had no statistical difference (P ＞ 0.05).The atrial fibrillation rate of right thoracic group was obviously lower than that of left thoracic group,the difference was statistically significant (P＜ 0.05).The overall survival and recurrence rate of two groups during the follow-up in 3 years had no statistical difference (P ＞ 0.05).Conclusion The left and right thoracic surgical approach can be as the alternative paths in period of esophageal squamous carcinoma,but right thoracic approach for the dissection of lymph nodes is more complete.
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