| Background:Esophageal Carcinoma is one of the usual alimentary cancer clinically,worldwidely,there is difference in area,race and the type of pathologr.China is a high density country about this cancer,Every year,there are 3 million neopathy all over the world,and more than half of them are in china.Currently,surgical treatment is the major therphy aim to this disease.Esophageal surgery has developed for almost 100 years.Esophagectomy can be performed via left,right thoracotomy,even via hiatus without thoracotomy due to its unique anatomic characteristics.Left thoracotomy was the initial approach in the world,and has still been performed by chinese colleagues,but Ivor Lewis(right side thoracotomy)procedure is popular in western countries. Currently, esophagectomy by right thoracotomy has been accepted worldwidely since its radical dissection for tumor. But now,there is still severity dispute on the question above-mentioned.In the area of oncological surgery,there is no disease like esophageal carcinoma have so much dispute on the modus operandi.So,to research the merit and demerit of different modus operandi is worthiness.Objective:Compare and evaluate the advantages and disadvantages of two surgical approaches-left posterlateral thoracotomy incision and right posterolateral thoracotomy incision plus ventral midline incision for Esophageal Carcinoma,So as to provide theoretical basis to select a suitable operation.Methods:Review 100 Esophageal Carcinoma cases in the Middle-Lower Section received operation in 1st affiliated hospital of Soochow University from January,2014 to January,2015.They are divided into two groups-50 with left posterolateral thoracotomy incision and 50 with right posterolateral thoracotomy plus ventral midline incision.Then select sevsral operation 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 dats to check whether they have have significant differences.Results:There are no significant differences in sexuality and age between two groups(P>0.05).The average operation time of single incision group is 205.48 ±35.88 min,faster than double incision group 270.10±52.91min(P<0.01).Averge number of lymph nodes scavenged of single incision group is l8.96±5.52,less than double incision group 12.50±2.26(P<0.05).but the number of the postive ones are 1.08±1.15 and 1.58±1.86 respectively(P>0.05),which show no great differences.Average days of indwelling chest tube of single incision group after operation is 6.00±3.42,less than double incision group 8.14 ± 6.38(P<0.05).The total body fluid loss of single incision group is 2312.80±869.78ml/m2,less than double incision group 3173.34±2212.58ml/m2(P<0.05).The average days in wards after operation is 14.76±6.30,while that of double incision group is 17.10±7.87(P>0.05).Hospital cost of single incision group is 62002.89±19983.70 yuan,while that of double incision group is 69727.89±27685.11yuan(P>0.05). The postive staining rates of incisal edge of the specimen are 4% and 2%respectively for single and double incision group(P>0.05).Incidence rate of post-operative complication are 30% and 44% 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 in wards after operation and hospital cost.Single incision group is superior to double incision group in average days of indwelling chest tube and the total body fluid loss,while inferior in number of lymph nodes scavenged.No great differences in postive staining rates of incisal edge for esophageal carcinoma of middle section.But for midle-lower section and lower section,double incison is superior to single incision. |
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