本文選題：胸中段食管癌 + 手術(shù)入路�。� 參考：《山東大學(xué)》2015年碩士論文

【摘要】：研究背景：在中國最常見的食管惡性腫瘤是食管鱗狀細胞癌,食管的胸中段是食管鱗癌的好發(fā)部位,對于早、中期食管鱗狀細胞癌的首選治療方式仍是手術(shù)治療。目前國內(nèi)治療胸中段食管鱗癌最常用的兩種手術(shù)路徑為經(jīng)左胸入路和經(jīng)右胸入路。其中經(jīng)左胸入路根據(jù)吻合部位的不同分為經(jīng)左胸的食管癌切除、胃食管左頸部吻合術(shù)和經(jīng)左胸的食管癌切除、主動脈弓上胃食管吻合術(shù)；根據(jù)右胸入路吻合部位的不同分為右后外側(cè)切口開胸+腹部正中開腹(Ivor-Lewis術(shù))和頸胸腹聯(lián)合三切口食管癌切除術(shù)。目的：比較右胸、上腹部、左頸部三切口和左胸、頸部兩切口入路治療胸中段食管鱗癌的圍手術(shù)期并發(fā)癥及療效差異。方法：選取我院自2006年12月至2008年12月收治的97例食管癌手術(shù)患者,術(shù)前及術(shù)后病理均證實為鱗狀細胞癌,其中55例經(jīng)右胸入路(觀察組),42例經(jīng)左胸入路(對照組),回顧性分析這兩種徑路的術(shù)后引流量、手術(shù)并發(fā)癥、淋巴結(jié)清掃情況及生存率并進行統(tǒng)計學(xué)分析。結(jié)果：右胸組術(shù)后因吻合口瘺及呼吸功能衰竭死亡2例,左胸組無死亡病例；右胸組并發(fā)癥與左胸組并發(fā)癥發(fā)生率大多無顯著差異,但右胸組肺部感染、心律失常發(fā)生率差異有顯著性(P0.05)；觀察組清掃淋巴結(jié)990個,陽性率23.8%,對照組清掃淋巴結(jié)504個,陽性率12.4%(P0.05)；右胸組5年生存率(45.5%)高于左胸組5年生存率(21.4%)(P0.05)；觀察組手術(shù)時間及術(shù)中失血量與對照組相比差異有顯著性(P0.05),術(shù)后第1天引流量無顯著差異。結(jié)論：對于一般情況良好,并且又無法確定上縱膈及頸部有無淋巴結(jié)轉(zhuǎn)移的食管癌患者,有選擇性的行右胸三切口手術(shù)是一個比較好的方式。
[Abstract]:Background: the most common esophageal malignant tumor in China is squamous cell carcinoma of the esophagus, the middle part of the esophagus is the predilection site of esophageal squamous cell carcinoma. Surgical treatment is still the first choice for early and middle stage esophageal squamous cell carcinoma. At present, the two most common surgical approaches for middle thoracic esophageal squamous cell carcinoma in China are left thoracic approach and right thoracic approach. According to the site of anastomosis, the transthoracic approach was divided into three groups: esophagectomy via left chest, gastroesophagoesophagostomy by left neck anastomosis, esophagectomy via left thoracic esophagectomy, and gastroesophageal anastomosis by upper aortic arch. According to the anastomosis site of the right thoracic approach, we divided the right posterolateral incision into right posterolateral incision and Ivor-Lewis thoracostomy (median thoracotomy) and combined cervical, thoracoabdominal and three-incision esophagectomy. Objective: to compare the perioperative complications and curative effect of right chest, upper abdomen, left neck three incisions and left chest and neck incision in the treatment of middle thoracic esophageal squamous cell carcinoma. Methods: from December 2006 to December 2008, 97 patients with esophageal carcinoma were selected and proved to be squamous cell carcinoma (SCC) before and after operation. Among them, 55 cases underwent right thoracic approach (observation group 42 cases underwent left thoracic approach (control group), the drainage, complications, lymph node dissection and survival rate of the two approaches were analyzed and statistically analyzed. Results: two cases died of anastomotic fistula and respiratory failure after operation in the right chest group, but no death occurred in the left chest group, but there was no significant difference in the incidence of complications between the right thoracic group and the left thoracic group, but pulmonary infection was found in the right chest group. The incidence of arrhythmia was significantly different between the observation group and the control group, 990 lymph nodes were dissected and the positive rate was 23.8in the observation group, 504 lymph nodes were dissected in the control group. The 5-year survival rate in the right chest group was higher than that in the left chest group (P 0.05), the operative time and blood loss in the observation group were significantly different from those in the control group, and there was no significant difference in drainage flow on the first day after operation. Conclusion: for the patients with esophageal carcinoma who are in good condition and can not determine whether the upper mediastinum and neck have lymph node metastasis, the selective triple incision of right chest is a better method.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R735.1

【參考文獻】

相關(guān)期刊論文 前4條

1 馮慶來,尚淑艷,趙錫江;胸段食管癌淋巴結(jié)轉(zhuǎn)移規(guī)律的探討[J];中國腫瘤臨床;2005年12期

2 王建華;;胸腹二野淋巴結(jié)清掃治療胸段食管鱗癌的中期療效[J];中國腫瘤臨床;2007年10期

3 齊戰(zhàn),朱德成,陳萬生,平育敏,張振明,路立軍;胸胃對食管癌圍術(shù)期呼吸功能的影響[J];中華胸心血管外科雜志;2000年03期

4 王延明,臧玉林,張國平,宋宇宏,李險波;食管癌切除術(shù)后切緣癌陽性的相關(guān)因素[J];中華胸心血管外科雜志;1999年04期

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