CAJ | 학술논문

目的探讨改良胸腹联合切口并器械吻合行贲门癌根治术的优缺点及可行性.方法改良术式62例(观察组)与随机抽取同期行传统胸腹联合切口术式(对照组Ⅰ)、经腹术式(对照组Ⅱ)和经左胸术式(对照组Ⅲ)各62例进行对照分析,比较各组患者平均手术时间、平均住院天数、术中出血量、术后心肺并发症情况、切缘阳性率以及淋巴结清除情况.结果对照组Ⅰ患者的平均手术时间、平均住院天数高于对照组Ⅱ和对照组Ⅲ,但是肿瘤切除范围和淋巴清扫范围明显高于对照组Ⅱ；观察组的平均手术时间、平均住院天数和术中出血量显著低于对照组Ⅰ,而且肿瘤切除和淋巴结清扫范围与对照组Ⅰ相近；各组间并发症发生率比较差异无显著性.结论虽然传统胸腹联合切口的术后心肺并发症发生率与改良切口、经胸和经腹切口相比差异无显著性,但是改良切口组的并发症发生率明显低于传统切口组.改良手术路径具有创伤小、患者术后恢复快、根治彻底等优点,值得进一步探讨.
목적 탐토개량흉복연합절구병기계문합행분문암근치술적우결점급가행성.방법 개량술식62례(관찰조)여수궤추취동기행전통흉복연합절구술식(대조조Ⅰ)、경복술식(대조조Ⅱ)화경좌흉술식(대조조Ⅲ)각62례진행대조분석,비교각조환자평균수술시간、평균주원천수、술중출혈량、술후심폐병발증정황、절연양성솔이급림파결청제정황.결과 대조조Ⅰ환자적평균수술시간、평균주원천수고우대조조Ⅱ화대조조Ⅲ,단시종류절제범위화림파청소범위명현고우대조조Ⅱ；관찰조적평균수술시간、평균주원천수화술중출혈량현저저우대조조Ⅰ,이차종류절제화림파결청소범위여대조조Ⅰ상근；각조간병발증발생솔비교차이무현저성.결론 수연전통흉복연합절구적술후심폐병발증발생솔여개량절구、경흉화경복절구상비차이무현저성,단시개량절구조적병발증발생솔명현저우전통절구조.개량수술로경구유창상소、환자술후회복쾌、근치철저등우점,치득진일보탐토.
Objective To investigate the advantage and disadvantage and the feasibility of modified thoracoabdomianl incision with instrumental anastomosis for gastric cardia carcinoma.Methods 62 patients who scheduled for modified procedure were assigned to a study group; and 62 patients who randomly scheduled for conventional thoracoabdominal,transabdominal,or transthoracic incision in the same period were allocated to control group Ⅰ,Ⅱ,or Ⅲ.Average surgical duration,average length of hospital stay,intraoperative blood volume,postoperative cardiopulmonary complications,positive rate incision margins and clearance of lymph nodes were compared among the groups.Results The average surgical duration and length of hospital stay were longer in group Ⅰ than in groups Ⅱ and Ⅲ.The extents of tumor excision and lymph node clearance were significantly greater in group Ⅰ than in group Ⅱ.The average surgical duration and length of hospital stay were markedly longer and the intraoperative blood valume was obviously smaller in the study group than in group Ⅰ,while the extents of tumor excision and lymph node clearance were similar.The rate of complications did not differ significantly among the groups.Conclusions Modified thoracoabdominal incision has a markedly lower rate of complications than traditional methods,is less invasive,and a shorter convalescence period.It is worth further being studied.