目的 比较研究经腹及经胸两种不同术式治疗贲门癌的临床结果。方法 选取2014年1月—2017年12月收治的贲门癌患者198例,以手术方式不同分为研究组（经腹贲门癌切除者）108例和对照组（经左胸贲门癌切除者）90例。统计两组患者的一般临床资料,分析比较两组患者手术时间、术中及术后出血量、术后并发症、淋巴结清扫率,切缘的阳性率,TNM（Tumor Node Metastasis）临床分期、住院死亡率、平均住院时间,术后5年随访结果等。结果 两组患者临床一般资料比较差异无统计学意义（P>0.05）。研究组在手术时间、术中及术后出血量、术后并发症、淋巴结清扫率,平均住院时间方面优于对照组,差异有统计学意义（P<0.05）。研究组在切缘的阳性率与对照组相当,两组均能达到完整切除,两组5年生存率统计学未见明显差异（P>0.05）。结论 经胸贲门癌根治术虽然能够增加食管下段切除的长度、清扫纵膈淋巴结,但该术式术后并发症发生率高,手术创伤较大,术后5年生存率改善不明显,因此经腹手术推荐应用于本组贲门癌患者。
Objective To compare the clinical outcomes of patients with cardiac cancer undergoing radical resection by laparotomy or thoracotomy. Methods A total of 198 patients with cardiac cancer were selected from January 2014 to December 2017. Among them, 108 patients in the study group received trans-abdominal cancer resection and 90 patients in the control group received trans-thoracic cancer resection. General clinical characteristics, surgery time, intraoperative and postoperative hemorrhage volumes, postoperative complications, lymph nodes resection rate, positive surgical margins, tumor node metastasis （TNM） stages, hospital mortality rate, hospital stay, and 5-year survival were compared between the two groups. Results No significant difference was found in general clinical characteristics （P>0.05）. Compared with the control group, the surgery time, intraoperative and postoperative hemorrhage volumes, postoperative complication rate, lymph nodes resection rate, and hospital stay were superior in the study group （P<0.05）. No difference in positive surgical margin rate was found between the two groups, both with complete resection. There was no significant difference in 5-year survival rate between the two groups （P>0.05）. Conclusion Complications more frequently happen, operative trauma is larger, and 5-year survival is not increased after trans-thoracic cardiac cancer resection, though more esophagus and mediastinal lymph nodes can be removed. Therefore, trans-abdominal cardiac cancer resection is recommended.
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