CAJ | 학술논문

目的：分析比较左右胸不同路径手术对胸中段食管癌患者的治疗效果。方法将我院施行手术的120例胸中段食管癌患者分为观察组与对照组各60例，观察组作右胸、腹部、颈部三切口手术；对照组行单纯左胸入路手术。分析比较两组患者的手术时间、术后住院及留置胸管时间、淋巴结清除数目、食管残端阳性率、术后并发症及2年存活率等指标。结果观察组手术时间、术后住院时间、清除淋巴结数目及2年存活率明显高于对照组；食管残端阳性率显著低于对照组(P<0.05)；观察组术后肺部感染及吻合口瘘发生率较高(P<0.05)。结论与单纯左胸入路手术相比，经右胸、腹部、颈部三切口的右胸路径手术的疗效更佳，对上纵隔及腹腔的淋巴结清除更彻底，不易复发，2年存活率高，但手术耗时较长，术后肺部感染及吻合口瘘发生率偏高，应根据患者具体情况选择适宜的手术路径。
목적：분석비교좌우흉불동로경수술대흉중단식관암환자적치료효과。방법장아원시행수술적120례흉중단식관암환자분위관찰조여대조조각60례，관찰조작우흉、복부、경부삼절구수술；대조조행단순좌흉입로수술。분석비교량조환자적수술시간、술후주원급류치흉관시간、림파결청제수목、식관잔단양성솔、술후병발증급2년존활솔등지표。결과관찰조수술시간、술후주원시간、청제림파결수목급2년존활솔명현고우대조조；식관잔단양성솔현저저우대조조(P<0.05)；관찰조술후폐부감염급문합구루발생솔교고(P<0.05)。결론여단순좌흉입로수술상비，경우흉、복부、경부삼절구적우흉로경수술적료효경가，대상종격급복강적림파결청제경철저，불역복발，2년존활솔고，단수술모시교장，술후폐부감염급문합구루발생솔편고，응근거환자구체정황선택괄의적수술로경。
Objective To compare and analyze the surgical efficacy of different ways of left and right transthoracic ap-proaches on patients with middle thoracic esophageal cancer. Methods The 120 patients with middle esophageal carci-noma were divided into observation group (60 cases) and the control group (60 cases) randomly. The patients in obser-vation group were treated with right chest-belly-neck three-incision. The control group accepted left breast single in-cision. The operation duration, postoperative hospitalization time and indwelling chest tube time, the number of lymph node dissection, the rate of proximal spread of tumor, incidence of postoperative complications and 2-year survival rate were recorded and analyzed. Results Compared with control group, the operation duration, postoperative hospitalization time, the number of lymph node dissection and 2-year survival rate in observation group were higher. The rate of proximal spread of tumor in observation group were lower than in control group (P<0.05). The incidence of pulmonary infection and anastomotic leak were higher (P<0.05). Conclusion Compared with left breast single incision, right chest-belly-neck three-incision can provide a wider extent of lymphadenectomy, especially for mediastinal and abdominal, which may improve the survival in two years of patients with middle esophageal carcinoma. But the operation time may be longer and the incidence of pulmonary infection and anastomotic leak may be higher. Surgery should be selected according to the specific circumstances of patients.