By Comparing Two Route Of Radical Resection Of Esophageal Carcinoma, The Right Chest Of Posterolater Plus Upper Abdomen And The Left Side Of Posterolateral,Studying Of The Influence Of The Pulmonary Functions

Objective:The study compared right anterolateral thoracotomy plus ventral midline incision and the left posterior lateral incision two into the road on postoperative lung function in patients with.Methods:2011year January to October2012admitted to our department for elective thoracotomy esophageal cancer radical surgery patients in this study. Inclusion criteria:1preoperative esophageal swallow barium and fiber endoscopy diagnosed with esophageal cancer;2in the esophagus;3newly diagnosed patients who had not received chemotherapy and surgery; the;4preoperative vital capacity (VC), forced vital capacity first second forced vital capacity (FVC)(FEV1) and maximal voluntary ventilation (MVV) is expected to more than70%of the normal.Exclusion criteria:1tumor obviously foreign invasion and mediastinal lymph nodes, distant metastasis;2inoperable heart, liver, kidney and other vital organ dysfunction;3severe thoracic spinal deformity;4other history of cancer; Were included in the study136patients divided into observationgroup and control group, according to the date of admission, each group68cases. The observation group,50males and18females; aged49to71years old, mean (61.5±6.6) years old;45cases of cancers is located at middle segment of the esophageal,23is located at lower segment of the esophageal; pathological types:squamous cell carcinoma is in48cases,11cases is adenocarcinoma, adenosquamous carcinoma is in9cases. The control group situation included:48males and20females; aged from46to70years old, on average (61.2±6.5); middle segment lesions in43cases of esophageal cancer,25patients lesions is at lower segment of esophgus; pathological types:squamous cell carcinoma in46cases,12cases of is adenocarcinoma, adenosquamous carcinoma is in10cases. The right anterolateral of thoracic incision plus upper midline abdomen were used in the observation group. Otherwise, the left posterior lateral incision of esophageal cancer were used in the control group. The operation time of the two groups were compared, included the time of the exposed of the chest, the intraoperative single lung ventilation, the patient’s arterial blood gas analysis and pulmonary function werer analysis at the preoperative and postoperative one week and one month.Results:All cases of the esophgus cancer nomater what kind of groups were done by the cancer radical surgery; double-lumen endotracheal intubation; general anesthesia. In the obervation group, the patient postion is the supine an abdominal incision firstly, The stomach tissus is freely fully from the around the organs, and than the right side of anterolateral chest incision to explored the esophageal cancer. Under the up of the diaphragm2-3cm,the surgeon cut the diseases cancer, the stomach tissus is elevared through the diaphragmatic hiatus to the chest cavity, in the right chest esophageal anastomosis.The intraoperative intravenous and inhalation composite maintain anesthesia.Surgery process during the operation is in the one-lung ventilation, and other time is in the double lung ventilation.Left posterior lateral incision radical resection of esophageal cancer.Esophageal along with the left sternocleidomastoid front of neck incision, the diaphragm is cut, gastroesophageal aortic arch, arch, or the top of the chest equipment anastomosis or hand suture, and the rest measures of the operation is same as the observation group.1. patient surgery time, the chest opening hours, intraoperative single-lung ventilation;2.respectively, before surgery, after1week and1month after to take radial artery determination of the patient’s arterial blood gas analysis, the instrument is Roche Roche, Switzerland OMNIC blood gas analyzer, the main indicators include:blood oxygen pressure (PaO2), carbon dioxide partial pressure (PaCO2) and arterial oxygen saturation (SaO2);3.respectively, before surgery, after one week, one month after the determination of patients pulmonary function analyzer pulmonary function instrument producted by the JAEGER Flowscreen, Jaeger, Germany, References [6], the patient is fully awake and in the seats were examized include:VC, FVC, FEV1, MVV, data are percentage of predicted value is expressed as a percentage of the actual value. Statistical analysis:SPSS13.0statistical software for data analysis, measurement datas that compared with paired t-test, P<0.05for the difference was statistically significant.Conclusion:The esophageal cancer via right anterolateral thoracotomy and upper abdomen incision route can shorten the time of intraoperation and intraoperative one-lung ventilation.This method route also avoid damage to the diaphragm.Comparable the rountine incision "the left posterior lateral approach", less influence in the pulmonary function and benifited to protect the postoperative pulmonary function.