CAJ | 학술논문

目的：比较中段食管癌手术治疗术式的利弊，以提高食管癌的手术疗效。方法选择2010年1月至2012年6月位于食管中段的食管癌住院手术患者110例，依据术式不同，即经右胸Ivor-Lewis手术和左胸Sweet手术，将病例分为Ivor-Lewis组55例和Sweet组55例。对比分析2组术后切除标本的食管长度、肿瘤浸润和切除距离、切缘癌残留的发生率、胸腔和腹腔淋巴结清除的数量及癌浸润淋巴结的阳性率等，并以问卷调查的方式对医师参加Ivor-Lewis组和Sweet组术中处理胸部和腹部的解剖学问题进行评分比较。结果在食管切除长度、淋巴结清除个数方面Ivor-Lewis组明显大于Sweet组(P<0.01)；Ivor-Lewis组食管癌切缘癌残留阳性发生率为1.82%，显著低于Sweet组的21.82%(P<0.01)；问卷调查手术医师对2组术中解剖问题评分Ivor-Lewis组明显优于Sweet组。结论食管中上段癌外科手术建议采取Ivor-Lewis术式，贲门部及下段食管癌适宜Sweet手术。
목적：비교중단식관암수술치료술식적리폐，이제고식관암적수술료효。방법선택2010년1월지2012년6월위우식관중단적식관암주원수술환자110례，의거술식불동，즉경우흉Ivor-Lewis수술화좌흉Sweet수술，장병례분위Ivor-Lewis조55례화Sweet조55례。대비분석2조술후절제표본적식관장도、종류침윤화절제거리、절연암잔류적발생솔、흉강화복강림파결청제적수량급암침윤림파결적양성솔등，병이문권조사적방식대의사삼가Ivor-Lewis조화Sweet조술중처리흉부화복부적해부학문제진행평분비교。결과재식관절제장도、림파결청제개수방면Ivor-Lewis조명현대우Sweet조(P<0.01)；Ivor-Lewis조식관암절연암잔류양성발생솔위1.82%，현저저우Sweet조적21.82%(P<0.01)；문권조사수술의사대2조술중해부문제평분Ivor-Lewis조명현우우Sweet조。결론식관중상단암외과수술건의채취Ivor-Lewis술식，분문부급하단식관암괄의Sweet수술。
Objective In order to improve the surgical treatment for midpiece esophageal carcinoma, different surgical ways were com-pared. Methods From January 2010 to June 2012, 110 patients with midpiece esophageal cancer in our hospital were divided into the Ivor-Lewis group (55 cases) and the Sweet group (55 cases) according to different surgical ways, that is to say Ivor-Lewis surgery via right chest and Sweet surgery through left chest. Length of specimens, rang of tumor invasion, distance of removal, incidence of residual carcinoma in the esophageal edges, number of lymph nodes removed in chest and abdomen, and positive rate of carcinoma infiltrated lymph nodes were compared between the two groups. Questions of surgical anatomy were investigated through questionnaire among surgeons of the two groups, and the scores of both groups were analysed. Results The length of resected specimens and number of lymph nodes removed in Ivor-Lewis group was significantly lager than that of the Sweet group (P<0. 01). The positive rate of carcinoma infiltrated lymph nodes in Ivor-Lewis group was 1. 82%, which was significantly lower than 21. 82% in the Sweet group (P<0. 01). Results of questionnaire showed surgeons have gieven higher scores to Ivor-Lewis group. Conclusion Ivor-Lewis surgery is recommend for upper and midpiece esophageal carcinoma while Sweet surgery is more suitable for cardial and lower esophageal cancer.