CAJ | 학술논문

目的：探讨经左、右胸2种不同手术入路治疗食管中下段癌的临床效果。方法选择食管中下段癌患者60例。在治疗过程中，按分配床位单、双数，将患者分为2组，采取不同的入路方式，即左胸后外侧入路组（左胸组）；右胸前外侧、腹正中入路组（右胸组）。结果右胸组手术时间、术中出血量较左胸组显著增加（P＜0．001）。右胸组围手术期并发症发生率为44．9％，左胸组为23．1％（P＜0．001）。其中，右胸组肺部并发症发生率较左胸组明显增多（14．1％VS 7．1％，P＜0．001）。左胸组平均清扫淋巴结（12±5）枚，右胸组（18±10）枚（P＜0．001）。从送检淋巴结的解剖分布情况来看，右胸组平均清扫上纵隔淋巴结（包括右喉返神经旁、胸内气管旁组淋巴结）数目明显比左胸组增多。右胸组局部复发率及远处转移率均低于左胸组（P＜0．05）。结论对于食管中下段癌，选择右胸手术入路更为合理。
목적：탐토경좌、우흉2충불동수술입로치료식관중하단암적림상효과。방법선택식관중하단암환자60례。재치료과정중，안분배상위단、쌍수，장환자분위2조，채취불동적입로방식，즉좌흉후외측입로조（좌흉조）；우흉전외측、복정중입로조（우흉조）。결과우흉조수술시간、술중출혈량교좌흉조현저증가（P＜0．001）。우흉조위수술기병발증발생솔위44．9％，좌흉조위23．1％（P＜0．001）。기중，우흉조폐부병발증발생솔교좌흉조명현증다（14．1％VS 7．1％，P＜0．001）。좌흉조평균청소림파결（12±5）매，우흉조（18±10）매（P＜0．001）。종송검림파결적해부분포정황래간，우흉조평균청소상종격림파결（포괄우후반신경방、흉내기관방조림파결）수목명현비좌흉조증다。우흉조국부복발솔급원처전이솔균저우좌흉조（P＜0．05）。결론대우식관중하단암，선택우흉수술입로경위합리。
Objective To investigate the clinical efficacy of left and right transthoracic operative approaches for middle and lower esophageal cancer. Methods 60 patients with middle and lower esophageal cancer were included. According to the distribution of beds,the patients were divided into 2 groups:the left chest posterolateral group (left transthoracic operative ap-proach group ) and the right chest anterolateral ,ventral midline group ( right transthoracic operative approach group ). Results The operation time and intraoperative bleeding volume in the right thoracic group was significantly higher than that of the left thoracic group(P<0.001).The perioperative complication rate was 44.9% in the right thoracic group,and 23.1% in the left thoracic group (P<0.001).The incidence rate of respiratory complications of the right thoracic group was higher than that of the left tho -racic group (14.1%VS 7.1%,P<0.001).The left thoracic group average lymph node dissection was (12 ±5),and the right thoracic group was (18 ±10) (P<0.001).From the distribution of lymph node dissection ,the right thoracic group average dis-section of mediastinal lymph nodes ( including the right recurrent laryngeal nerve side , intrathoracic paratracheal lymph node group) were higher than that of the left thoracic group. Local recurrence rate and distant metastasis rate of the right thoracic group was lower than that of the left thoracic group (P<0.05).Conclusion Right transthoracic operative approach is more reasonable for middle and lower esophageal cancer.