Mäkelä J, Laitinen S, Kairaluoma M I
Department of Surgery, University Central Hospital, Oulu, Finland.
Ann Chir Gynaecol. 1991;80(4):340-5.
The transthoracic and transhiatal resection techniques are compared using the 30-year experience of Oulu University Central Hospital. During the period 1960-1982 we favoured resections trough a transthoracic route, while during the period 1983-1989 a transhiatal route was preferred. This change, and the more enthusiastic attitude adopted towards resection, has lead to an increase in resectability from 23% (46/203) to 62% (43/69) (P less than 0.0001). The difference between radical resections, 50% (23/46) and 37% (16/43) has remained non-significant. Morbidity was higher after transthoracic than transhiatal resections, 57% (26/46) versus 42% (18/43), whereas mortality was nearly the same, 11% (5/46) and 9% (4/43). Postoperative pulmonary complications occurred in 28% (13/46) after transthoracic resection and in 14% (6/43) after transhiatal resection. No significant difference was detected in the development of late anastomotic strictures, 33% (15/46) and 30% (13/43), respectively. We conclude that transhiatal resection is as safe as transthoracic resection and seems to allow more resections to be carried out without any increase in mortality or morbidity, but long-term survival remains poor.
利用奥卢大学中心医院30年的经验，对经胸和经裂孔切除技术进行了比较。在1960 - 1982年期间，我们倾向于经胸途径进行切除，而在1983 - 1989年期间，更倾向于经裂孔途径。这种变化以及对切除采取的更积极态度，使可切除率从23%（46/203）提高到了62%（43/69）（P小于0.0001）。根治性切除率分别为50%（23/46）和37%（16/43），两者之间的差异仍无统计学意义。经胸切除后的发病率高于经裂孔切除，分别为57%（26/46）和42%（18/43），而死亡率几乎相同，分别为11%（5/46）和9%（4/43）。经胸切除术后肺部并发症发生率为28%（13/46），经裂孔切除术后为14%（6/43）。晚期吻合口狭窄的发生率分别为33%（15/46）和30%（13/43），未发现显著差异。我们得出结论，经裂孔切除与经胸切除一样安全，似乎可以进行更多切除，而不会增加死亡率或发病率，但长期生存率仍然很低。
