荣振华　高双庆　魏煜程

【摘要】 目的：对胸中下段的食管癌手术方式的选择进行研究，为中下段食管癌临床手术方式的选择提供依据。方法：回顾分析235例下段食管癌手术病例，按手术方式将其分为左胸单切口组（Sweet术式）110例和右胸+上腹正中两切口组（Ivor-Lewis术式）125例。比较两组患者以下指标：（1）手术时间（手术计时从切皮至缝皮结束）；（2）胸腔引流管留置时间；（3）胸腹二野淋巴结清扫数目；（4）术后住院时间；（5）食管切缘阳性率；（6）围手术期并发症发生率：包括吻合口瘘、吻合口狭窄、肺部并发症、喉返神经损伤、乳糜胸及胃排空障碍。结果：单切口组的手术时间明显短于两切口组，淋巴结清扫数目明显少于两切口组，差异均有统计学意义（P<0.001）。单切口组术后平均胸腔引流管留置时间及住院时间均短于双切口组，但两组比较差异均无统计学意义（P>0.05）。两组食管上切缘阳性率及围手术期并发症发生率比较差异均无统计学意义（P>0.05）。结论：从两组病例的比较又可以看出Sweet术式组比Ivor-Lewis术式组手术时间短。Ivor-Lewis手术组比Sweet术组视野暴露好，清扫淋巴结清扫彻底；两组在围术期并发症发生率、住院时间方面无显著差别。

【关键词】 胸下段食管癌； 手术方式； 左胸单切口

【Abstract】 Objective：To study the choice of middle and lower thoracic esophageal carcinoma surgery mode，so as to provide basis for clinical surgery mode of middle and lower esophageal carcinoma.Method：235 patients with lower segment esophageal cancer were retrospectively analyzed.They were divided into the left chest single incision group（Sweet operation group） for 110 cases and right chest and upper abdomen median incision group（Ivor Lewis operation group） for 125 cases according to the type of surgery.The following indicators between the two groups were compared，（1）the operation time（operation time from skin incision to skin suture end）；（2）the thoracic drainage tube indwelling time；（3）in abdominal two-field lymph node dissection number；（4）the postoperative hospital stay time；（5）positive rate of esophagus resection margin；（6）perioperative complications：the incidence of anastomotic leakage，anastomotic stenosis，pulmonary complications，larynx return nerve injury，chylothorax and gastric emptying disorder.Result：The operation time of the single incision group was significantly shorter than the double incision group，and the number of lymph nodes dissection in the single incision group was significantly less than the double incision group，the differences were statistically significant（P<0.001）.The average thoracic drainage tube indwelling time and length of stay in the single incision group were slightly shorter than the double incision group，but there were no statistically significant differences between the two groups（P>0.05）.And there were no statistically significant differences in positive rate of esophagus upper resection margin and incidence of perioperative complications between the two groups（P>0.05）.Conclusion：From the comparison of patients in the two groups，the operation time of Sweet operation group is shorter than that of Ivor-Lewis group，the visual field exposure of Ivor-Lewis operation group is better than the Sweet operation group，and can thoroughly clean the lymph nodes，there are no statistically significant differences in postoperative complications and length of stay between the two groups.

【Key words】 Lower thoracic esophageal carcinoma； Operation mode； Left chest single incision

First-authors address：Affiliated Hospital of Qingdao University，Qingdao 266000，China

doi：10.3969/j.issn.1674-4985.2016.05.019

食管癌是常见的消化道恶性肿瘤之一，严重危害患者的生命健康，对于中早期食管癌应以手术治疗为主[1-2]。本院自2008年开始开展胸中下段食管癌手术方式的临床研究，取得了满意的临床效果，现报告如下。

1 资料与方法

1.1 一般资料 选取2008年3月-2014年11月千佛山集团曹县医院收治的235例下段食管癌病例，按手术方式将其分为右胸+上腹正中两切口组（Ivor-Lewis术式）125例、左胸单切口组（Sweet术式）110例。组织……