Clinical Research Of Two Surgical Approaches For Esophageal Carcinoma In The Middle-Lower Section

Objective:Compare and evaluate the advantages and disadvantages of two surgical approaches—left posterolateral thoracotomy incision and right posterolateral thoracotomy incision plus ventral midline incision for Esophageal Carcinoma in the Middle-Lower Section, so as to provide theoretical basis to select a suitable operation.Methods:Review 90 Esophageal Carcinoma cases in the Middle-Lower Section received operation in 1st affiliated hospital of Zhe jiang University from March,2010 to March,2011.They are divided into two groups—50 with left posterolateral thoracotomy incision (single incision) and 40 with right posterolateral thoracotomy plus ventral midline incision(double incisions).Then select several operative and perioperative indexs such as Operation time, Number of lymph nodes scavenged, Positive staining rates of incisal edge of the specimen,compare the two sets of data to check whether they have significant differences.Resunts:There are no significant differences in sexuality and age between two groups (P> 0.05) The average operation time of single incision group is 225.6±44.0min, faster than double incision group 297.8±40.4min(P<0.01).Hospital cost of single incision group is 49096.8±11059.3yuan,less than double incision group 58618.6±13923.9yuan(P<0.05).Average number of lymph nodes scavenged of single incision group is 13.0±5.6,less than double incision group 18.7±7.4 (P<0.05),but the number of the positive ones are 1.04±1.14 and 1.50±1.83 respectively(P>0.05),which show no great differences. The average days in wards of single incision group after operation is 16.3±6.3,while that of double incision group is 14.4±4.2(P>0.05). Average days of indwelling chest tube of single incision group after operation is 11.1±3.1,no great difference with double incision group 11.2±3.3(P>0.05). The positive staining rates of upper incisal edge of the specimen are 14%and 24%respectively(P>0.05) for esophageal carcinoma in middle section,25%and 10%respectively for middle-lower section,4%and 0%respectively for lower section.Incidence rate of post-operative complications are 18%and 15%respectively for single and double incision group(P>0.05).Conclusion:Two surgical approaches show no great differences in incidence rate of postoperative complications, average days of indwelling chest tube after operation, average days in wards after operation.Single incision group is superior to double incision group in hospital cost and operation time,while inferior in number of lymph nodes scavenged.No great differences in positive staining rate of upper incisal edge for esophageal carcinoma of middle section.But for middle-lower section and lower section,double incision is superior to single incision.