摘要
目的探讨食管癌切除现代二野与传统二野淋巴结清扫不同手术方法对手术疗效的影响和临床实际应用价值。方法 1987年6月～2010年12月本院采用现代二野淋巴结清扫(A组)共治疗胸部食管癌1770例,经左胸径路作传统二野淋巴结清扫(B组)共治疗胸部食管癌220例,对两组临床资料进行对比分析,总结胸腹二野淋巴结转移的发生率、手术切除率、术后并发症的发生率及死亡率,并对两组术后1、3、5年生存率进行随访。结果 A、B两组手术切除率分别为96.9%(1770/1826)和85.3%(220/258),两组在右气管旁三角、上纵隔、下纵隔及腹区的淋巴结转移率分别为20.5%和0;25.8%和4.1%;17.5%和19.1%;20.3%和19.5%。术后并发症发生率两组分别为18.5%(327/1770)和18.2%(40/220),其中肺部并发症均占第一位。手术死亡率分别为0.28%(5/1770)和0.45%(1/220);两组术后1、3、5年的生存率分别为:87.5%(1470/1680)、62.8%(942/1500)、54.2%(732/1350)和78.3%(155/198)、58.4%(90/154)、28.2%(31/110)。结论长期的研究结果表明食管癌切除采用Ivor-Lewis和Akiyama术式对胸腹二野均有良好的显露,淋巴结清扫彻底、方便,尤其对右侧后上纵隔沿喉返神经旁、右胸顶、气管旁三角淋巴结清扫便利。特别对有淋巴结转移的食管癌患者行现代二野淋巴结清扫十分必要,优于传统二野淋巴结清扫,能明显提高术后5年生存率。
Objcetive To explore the operation therapeutic effect and the clinical application value of esophagectomy with modem two-field lymph node and traditional two-field lymph node dissection for patients with esophageal carcinoma.Methods One thousand seven hundred and seventy patients underwent esophagectomy with modem two-field dissection of lymph nodes（group A）,220 patients underwent esophagectomy with traditional two-field dissection of lymph nodes through left thoracotom incisions（group B） in our hospital from June 1987 to December 2010.The clinical data of two groups was compared and analyzed.The information of lymph node metastases,operative morbidity and mortality,postoperative complications and mortality of two group were summed up.The survival rates of 1,3,5 years after surgery were analyzed retrospectively.Results The operative resection rate of group A was 96.9%（1 770/1 826）,group B was 85.3%（220/258）.Two groups in the right tracheal side triangle,the superior mediastinum,mediastinal and abdominal lymph node metastasis rate were 20.5% and 0;25.8% and 4.1%;17.5% and 19.1%;20.3% and 19.5%.Incidence rate of postoperative complications between the two groups were 18.5%（327/1 770） and 18.2%（40/220）,the pulmonary complications were accounted for the first.Surgical mortality was 0.28%（5/1 770） and 0.45%（1/220）;The survival rates were 87.5%（1 470/1 680）,62.8%（942/1 500）,54.2%（732/1 350） and 78.3%（155/198）,58.4%（90/154）,28.2%（31/110） between the two groups at 1,3,5 year.Conclusion Long-term research results show that the esophageal cancer resection Ivor-Lewis and Akiyama operation to belly two-field all have a good show,lymph node dissection thoroughly,convenient,especially for the right after the mediastinal along the recurrent laryngeal nerve side,right chest top,tracheal side triangle lymph node dissection is convenient.Especially for a lymph node metastasis of esophageal cancer patients modern two wild lymph node dissection is very necessary,it is better than traditional two wild lymph node dissection,it can significantly improve the postoperative survival rate in 5 years.
出处
《中国当代医药》
2012年第36期28-30,共3页
China Modern Medicine
关键词
食管癌
食管切除术
二野淋巴结清扫
生存率
Esophageal carcinoma
Esophagectomy
Two-field lymph node dissection
Survival rate
