CAJ | 학술논문

目的：探讨食管癌患者不同手术方案术后并发症情况。方法将258例食管癌患者，按照经左胸（Sweet）、上腹右胸（Ivor-Lewis）、颈、胸、腹三切口（McKeown）及腔镜辅助等手术方式分为4组，分别比较4组在手术时间、术中出血情况、淋巴结清扫范围及术后并发症发生率等方面的异同。结果手术时间以腔镜组最长，经左胸组手术时间最短；经左胸和经上腹右胸手术组的上纵隔淋巴结清扫数量明显少于经三切口和腔镜手术组，差异有统计学意义（P＜0．05）。术中出血量及中下纵膈、腹腔淋巴结清扫数量4组相比，差异无统计学意义（P＞0．05）。经左胸、上腹右胸、三切口及腔镜手术4组患者呼吸衰竭并发症发生率分别为1．54％、3．23％、10．17％、2．78％，以三切口组最高；而腔镜组声音嘶哑发生率为4．17％，明显高于其他3组，差异有统计学意义（ P＜0．05）。而肺部感染、吻合口瘘、膈疝、乳糜胸、胃排空障碍及死亡等并发症发生率4组相比，差异均无统计学意义（P＞0．05）。结论经三切口手术对淋巴结的清扫更加彻底，但术后呼吸衰竭发生率也相对较高，而腔镜手术有创伤小、术后呼吸衰竭等呼吸系统并发症发生率低的优越性。
목적：탐토식관암환자불동수술방안술후병발증정황。방법장258례식관암환자，안조경좌흉（Sweet）、상복우흉（Ivor-Lewis）、경、흉、복삼절구（McKeown）급강경보조등수술방식분위4조，분별비교4조재수술시간、술중출혈정황、림파결청소범위급술후병발증발생솔등방면적이동。결과수술시간이강경조최장，경좌흉조수술시간최단；경좌흉화경상복우흉수술조적상종격림파결청소수량명현소우경삼절구화강경수술조，차이유통계학의의（P＜0．05）。술중출혈량급중하종격、복강림파결청소수량4조상비，차이무통계학의의（P＞0．05）。경좌흉、상복우흉、삼절구급강경수술4조환자호흡쇠갈병발증발생솔분별위1．54％、3．23％、10．17％、2．78％，이삼절구조최고；이강경조성음시아발생솔위4．17％，명현고우기타3조，차이유통계학의의（ P＜0．05）。이폐부감염、문합구루、격산、유미흉、위배공장애급사망등병발증발생솔4조상비，차이균무통계학의의（P＞0．05）。결론경삼절구수술대림파결적청소경가철저，단술후호흡쇠갈발생솔야상대교고，이강경수술유창상소、술후호흡쇠갈등호흡계통병발증발생솔저적우월성。
Objective To investigate postoperative complications in esophageal cancer patients treated with different op -eration methods.Methods 258 cases of esophageal cancer patients were divided into the left chest (Sweet)group,abdominal right chest (Ivor-Lewis)group,neck,chest,abdomen incision (McKeown)group and laparoscopic surgery group according to oper-ation methods.Operative time,blood loss,lymph node dissection and postoperative complication rates and other aspects of the 4 groups were compared .Results The laparoscopic surgery group had the longest operation time ,and the Sweet group had the shor-test operation time;Number of lymph node dissection of superior mediastinum in the Sweet group and the Ivor -Lewis group was significantly less than the McKeown group and the laparoscopic surgery group , the difference was statistically significant ( P<0.05).Blood loss,number of lymph node dissection of middle and inferior mediastinum of the 4 groups had no statistical differ-ence (P>0.05).Incidence rates of respiratory failure of the Sweet group ,the Ivor-Lewis group,the McKeown group and the lapa-roscopic surgery group were 1.54%,3.23%,10.17%,and 2.78%,with the McKeown group was the highest;incidence of hoarsenessthe in the laparoscopic surgery group was 4.17%,significantly higher than that of the other 3 groups,the difference was statistically significant (P<0.05).Incidence of lung infection,anastomotic fistula,diaphragmatic hernia,chylothorax,delayed gastric emptying and death of the 4 groups had no statistical difference (P>0.05).Conclusion Lymph node dissection is more thorough in the McKeown group , but the incidence of postoperative respiratory failure is relatively high; while the laparoscopic surgery group has less invasive surgery and fewer postoperative respiratory complications ,such as respiratory failure .