【摘要】 目的探讨胸腹联合小切口在贲门癌手术中的应用效果。方法我科于2002年1月~2007年1月对60例贲门癌患者行贲门癌切除术,经胸腹联合小切口30例,经后外侧切口30例,回顾分析2组资料。结果手术均获成功,无手术死亡及严重并发症发生。与后外侧切口组相比,胸腹联合小切口组的切口长度短[(12.4±0.7)cm vs(19.2±2.0)cm,t=-17.577,P=0.000],手术时间短[(207.3±76.1)min vs(260.0±85.6)min,t=-2.519,P=0.015],开始下床活动早[(2.3±0.5)d vs(3.4±0.5)d,t=-8.521,P=0.000],胸腔引流量少[(276.7±58.7)ml vs(308.7±59.5)ml,t=-2.097,P=0.040],哌替啶用量少[(66.7±27.3)mg vs(113.3±45.4)mg,t=-4.818,P=0.000],吸氧时间短[(3.8±2.0)d vs(5.1±2.6)d,t=-2.171,P=0.034],动脉血氧饱和度高[(97.6±2.7)%vs(96.1±2.7)%,t=2.152,P=0.036]。2组清扫胸腔淋巴结组数(1.87±0.43vs1.93±0.37,t=-0.579,P=0.565),清扫腹腔淋巴结组数(4.00±0.45vs3.97±0.49,t=0.247,P=0.806),术后住院时间[(11.8±1.0)d vs(12.0±1.2)d,t=-0.701,P=0.486],肺感染(2vs5,χ2=0.647,P=0.421),心房纤颤(2vs4,χ2=0.185,P=0.667)及切缘阳性(0vs1,χ2=0.000,P=1.000)无显著差异。随访时间[(36.3±13.9)月vs(36.3±16.5)月,t=0.024,P=0.981],1年生存(19vs22,χ2=0.487,P=0.485),3年生存(10vs12,χ2=0.194,P=0.660)及胸痛(2vs3,χ2=0.000,P=1.000)2组无显著差异。结论经胸腹联合小切口手术创伤小,有利于肿瘤的完整切除,是一个理想的手术入路。更多还原

【Abstract】 Objective To investigate the efficacy of thoracoabdominal mini-incision surgery for the treatment of gastric cardia cancer. Methods Radical resection of gastric cardia cancer was performed on 60 patients from January 2002 to January 2007. Thoracoabdominal mini-incision was used in 30 cases, and posterolateral thoracotomy was carried out in the other 30 patients. The data of the two groups were retrospectively analyzed. Results The operations were accomplished without death or severe complications in all the patients. Compared with the posterolateral thoracotomy group, thoracoabdominal mini-incision group had shorter incisions [(12.4±0.7) cm vs (19.2±2.0) cm, t=-17.577, P=0.000], shorter operation time [(207.3±76.1) min vs (260.0±85.6) min, t=-2.519, P=0.015], earlier postoperative ambulation [(2.3±0.5)d vs (3.4±0.5) d, t=-8.521, P=0.000], less thoracic drainage [(276.7±58.7) ml vs (308.7±59.5) ml, t=-2.097, P=0.040], less analgesic (pethidine) requirement [(66.7±27.3) mg vs (113.3±45.4) mg, t=-4.818, P=0.000], shorter duration of oxygen use [(3.8±2.0) d vs (5.1±2.6) d, t=-2.171, P=0.034], and higher arterial oxygen saturation[(97.6±2.7)% vs (96.1±2.7)%,t=2.152,P=0.036]. No significant difference was observed between the two groups in the number of dissected thoracic lymph nodes (1.87±0.43 vs 1.93±0.37, t=-0.579, P=0.565), number of dissected celiac lymph nodes (4.00±0.45 vs 3.97±0.49, t=0.247, P=0.806), postoperative hospital stay [(11.8±1.0) d vs (12.0±1.2) d, t=-0.701, P=0.486), pulmonary infection (2 vs 5, χ2=0.647, P=0.421), atrial fibrillation (2 vs 4, χ2=0.185, P=0.667) and positive surgical margins (0 vs 1, χ2=0.000, P=1.000). The two groups were followed up for (36.3±13.9) months and (36.3±16.5) months, respectively (t=0.024, P=0.981), no significant difference was detected between them in the 1- and 3-year survival cases (19 vs 22, χ2=0.487, P=0.485; and 10 vs 12, χ2=0.194, P=0.660) and chest pain (2 vs 3, χ2=0.000, P=1.000) during the period. Conclusions By using a thoracoabdominal mini-incision, gastric cardia cancer can be resected completely with less trauma. The approach is ideal for clinical application.更多还原