中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2011年
27期
1926-1928
,共3页
食管肿瘤%体位%治疗
食管腫瘤%體位%治療
식관종류%체위%치료
Esophageal neoplasms%Posture%Treatment
目的 探讨旋转变换体位胸腹联合切口治疗胸段食管癌的可行性.方法 2004年1月至2007年12月山西省人民医院胸外科采用旋转变换体位胸腹联合切口治疗胸段食管癌126例,男75例、女51例,年龄46～78岁,食管中段癌74例,食管下段癌52例.手术胸、腹部分期进行.患者基本体位采用左侧卧后仰30°～45°,取右胸第5肋间进胸,此时手术床向左旋转30°～45°,使胸部呈左侧位,开腹时手术床再向后旋30°～45.,使腹部近乎水平位,使胸腹部手术野均能够达到良好显露,如需颈部吻合或颈淋巴结清扫可一并同期完成.上述病例与同期行左胸及两切口手术的食管癌病例进行随机对照研究.结果 本组均顺利完成手术,食管胃右胸顶吻合74例,奇静脉弓水平吻合52例,两野淋巴结清扫平均25.6枚(16～32枚).无手术死亡,主要并发症:肺部感染5例,切口感染2例,喉返神经损伤5例,心律失常2例.采用旋转变换体位组的手术时间明显缩短,胸腹腔淋巴结清扫数目明显增加,无病生存期左胸组低于两切口组和旋转组,术中出血量、住院时间和术后胸腔引流差异无统计学意义.结论 胸段食管癌采用旋转变换体位胸腹联合切口胸顶部吻合可达到传统翻转体位手术的同样手术效果,术野暴露清楚,手术简便、省时、安全,为食管癌两野淋巴结清扫提供了一种可供选择的手术径路.
目的 探討鏇轉變換體位胸腹聯閤切口治療胸段食管癌的可行性.方法 2004年1月至2007年12月山西省人民醫院胸外科採用鏇轉變換體位胸腹聯閤切口治療胸段食管癌126例,男75例、女51例,年齡46～78歲,食管中段癌74例,食管下段癌52例.手術胸、腹部分期進行.患者基本體位採用左側臥後仰30°～45°,取右胸第5肋間進胸,此時手術床嚮左鏇轉30°～45°,使胸部呈左側位,開腹時手術床再嚮後鏇30°～45.,使腹部近乎水平位,使胸腹部手術野均能夠達到良好顯露,如需頸部吻閤或頸淋巴結清掃可一併同期完成.上述病例與同期行左胸及兩切口手術的食管癌病例進行隨機對照研究.結果 本組均順利完成手術,食管胃右胸頂吻閤74例,奇靜脈弓水平吻閤52例,兩野淋巴結清掃平均25.6枚(16～32枚).無手術死亡,主要併髮癥:肺部感染5例,切口感染2例,喉返神經損傷5例,心律失常2例.採用鏇轉變換體位組的手術時間明顯縮短,胸腹腔淋巴結清掃數目明顯增加,無病生存期左胸組低于兩切口組和鏇轉組,術中齣血量、住院時間和術後胸腔引流差異無統計學意義.結論 胸段食管癌採用鏇轉變換體位胸腹聯閤切口胸頂部吻閤可達到傳統翻轉體位手術的同樣手術效果,術野暴露清楚,手術簡便、省時、安全,為食管癌兩野淋巴結清掃提供瞭一種可供選擇的手術徑路.
목적 탐토선전변환체위흉복연합절구치료흉단식관암적가행성.방법 2004년1월지2007년12월산서성인민의원흉외과채용선전변환체위흉복연합절구치료흉단식관암126례,남75례、녀51례,년령46～78세,식관중단암74례,식관하단암52례.수술흉、복부분기진행.환자기본체위채용좌측와후앙30°～45°,취우흉제5륵간진흉,차시수술상향좌선전30°～45°,사흉부정좌측위,개복시수술상재향후선30°～45.,사복부근호수평위,사흉복부수술야균능구체도량호현로,여수경부문합혹경림파결청소가일병동기완성.상술병례여동기행좌흉급량절구수술적식관암병례진행수궤대조연구.결과 본조균순리완성수술,식관위우흉정문합74례,기정맥궁수평문합52례,량야림파결청소평균25.6매(16～32매).무수술사망,주요병발증:폐부감염5례,절구감염2례,후반신경손상5례,심률실상2례.채용선전변환체위조적수술시간명현축단,흉복강림파결청소수목명현증가,무병생존기좌흉조저우량절구조화선전조,술중출혈량、주원시간화술후흉강인류차이무통계학의의.결론 흉단식관암채용선전변환체위흉복연합절구흉정부문합가체도전통번전체위수술적동양수술효과,술야폭로청초,수술간편、성시、안전,위식관암량야림파결청소제공료일충가공선택적수술경로.
Objective To explore the clinical feasibility of thoracoabdominal incision for thoracic esophageal carcinoma by rotation position.Methods From January 2004 to December 2007,126 patients with thoracic esophageal carcinoma performed operation by rotation position.There were 75 males and 51 females aged 46 to 78 years.Tumor Was located mid-esophagus in 74 patients,whereas sub-esophagus was present in 52 patients.All patients underwent esophagectomy by rotation position(thoracoabdominal incision).Thoracic and abdominal cavity were exposed well.Results All operations were completed successful.Anastomotic stoma was located right thorax.The mean number of tow-field lymph node dissection was 25.6.There was no mortality.Postoperative complication include pulmonary complication,incision infection,recurrent laryneal nerve damage,arrhythmia.The operation time was significantly shortened by rotation position.The number of lymph node dissection was significantly increased.Conclusion The results of this study demonstrated that thoracoabdominal incision for thoracic esophageal carcinoma by rotation position exposes the operation fields clearly and make radical lymphadenectumy thoroughly.Disease-free survival is significantly improved.
