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目的:改进食管癌的手术入路,提高手术切除率,降低残端癌的发生率、手术死亡率,提高近期手术治疗效果。方法:我院胸外科自 1999年 1月~2002年 12月对 297例胸段食管癌患者,分别采用左胸后外侧切口 (Ⅰ组)、左胸后外侧切口+左颈切口(Ⅱ组)、右胸前外侧切口(Ⅲ组)、右胸后外侧切口(Ⅳ组)共完成食管癌食管切除术、经食管床食管重建术 293例。结果:本组手术切除率 98. 7% (293 /297),Ⅰ组、Ⅱ组、Ⅲ组、Ⅳ组分别为 98. 2%(86 /87)、98. 1% (52 /53)、98. 5% (133 /135)、100% (22 /22);手术死亡率 1. 7% (5 /297), Ⅰ组、Ⅱ组、Ⅲ组、Ⅳ组分别为 2. 3% (2 /87)、1. 9% (1 /53)、0. 75% (1 /135)、4. 5% (1 /22);断端癌发生率 3. 8% (11 /293), Ⅰ组、Ⅱ组、Ⅲ组、Ⅳ组分别为 4. 7% (4 /86)、3. 8% (2 /52)、2. 3% (3 /133)、9. 1% (2 /22);术后并发症发生率 12. 8% (38 /297), Ⅰ组、Ⅱ组、Ⅲ组、Ⅳ组分别为 17. 2% (15 /87)、9. 4% (5 /53)、11. 1% (15 /135)、13. 6% (3 /22)。Ⅲ、Ⅳ组与Ⅰ、Ⅱ组清扫的淋巴结均数相比,差异具有统计学意义(P<0. 05); Ⅰ、Ⅱ组间及Ⅲ、Ⅳ组间清扫的淋巴结均数相比,差异无统计学意义(P>0. 05)。结论:食管癌患者右胸前外侧三切口、右胸后外侧三切口全食管切除,可彻底清?
Objective: To improve the surgical approach of esophageal cancer, improve the resection rate, reduce the incidence of stump cancer, operative mortality and improve the effectiveness of recent surgical treatment. Methods: From January 1999 to December 2002, 297 patients with thoracic esophageal cancer were treated with left thoracotomy (group Ⅰ), left thoracotomy (left) and left cervical incision (group Ⅱ) , Right anterolateral thoracic incision (group Ⅲ) and right thoracic lateral incision (group Ⅳ) completed esophageal cancer esophagectomy and transesophageal bed esophageal reconstruction in 293 cases. Results: The resection rate was 98.7% (293/297) in the group Ⅰ, group Ⅱ, group Ⅲ and group Ⅳ, 98.2% (86/87) and 98.1% (52/53), respectively The rates of operative mortality were 1.7% (5/297) in group Ⅰ, group Ⅱ, group Ⅲ and group Ⅳ, respectively, which were 2.3% (2 / 87), 1.9% (1/53), 0.75% (1/135) and 4.5% (1/22) respectively. The incidence of stump cancer was 3.8% (11/293) Group Ⅱ, group Ⅲ and group Ⅳ were 4. 7% (4/86), 3.8% (2/52), 2.3% (3/133), 9.1% (2/22) ). The incidence of postoperative complications was 12.8% (38/297) in group Ⅰ, group Ⅱ, group Ⅲ and group Ⅳ were 17.2% (15/87) and 9.4% (5/53) , 11.1% (15/135), 13.6% (3/22). The difference was statistically significant (P <0.05) between group Ⅲ and group Ⅳ, as well as between group Ⅰ and group Ⅱ No statistical significance (P> 0.05). Conclusion: Three patients with esophageal right lateral thoracic incision, right thoracic lateral three incision total esophageal resection, can be completely cleared?