Goldminc M, Maddern G, Le Prise E, Meunier B, Campion J P, Launois B
Clinique Chirurgicale, Hôpital Pontchaillou, Rennes, France.
Br J Surg. 1993 Mar;80(3):367-70. doi: 10.1002/bjs.1800800335.
A prospective randomized trial of 67 patients undergoing oesophagectomy by either a transhiatal approach or right-sided thoracotomy was conducted over a 40-month period. In 32 patients the approach was transhiatal and 35 had a thoracotomy; the groups were well matched before operation. There were two hospital deaths in patients having the transhiatal oesophagectomy and three in those undergoing thoracotomy. Blood transfusion, intensive care stay and overall time of hospitalization were not significantly different between the two groups. There was no difference in the postoperative morbidity rate and, in particular, the incidences of pulmonary complications were similar (19 per cent for transhiatal oesophagectomy, 20 per cent for thoracotomy) with anastomotic fistula in 6 and 9 per cent respectively. The median (range) operating time was significantly longer in patients having thoracotomy (6 (3.5-9.5) versus 4 (3-8) h). Long-term survival was unaffected by the type of operation performed or addition of preoperative chemotherapy or radiotherapy. Nodal status was a significant prognostic factor within but not between the two groups. It is concluded that oesophagectomy by a transhiatal route or right thoracotomy are equally effective surgical options for treatment of squamous cell oesophageal cancer.
在40个月的时间里，对67例行经裂孔食管切除术或右侧开胸食管切除术的患者进行了一项前瞻性随机试验。32例患者采用经裂孔入路，35例采用开胸手术；两组在术前情况良好匹配。经裂孔食管切除术患者中有2例医院死亡，开胸手术患者中有3例。两组之间的输血、重症监护停留时间和总体住院时间无显著差异。术后发病率无差异，特别是肺部并发症的发生率相似（经裂孔食管切除术为19%，开胸手术为20%），吻合口瘘发生率分别为6%和9%。开胸手术患者的中位（范围）手术时间明显更长（6（3.5 - 9.5）小时对4（3 - 8）小时）。长期生存不受所施行手术类型或术前化疗或放疗的影响。淋巴结状态是两组内部而非两组之间的一个显著预后因素。结论是，经裂孔途径或右胸开胸食管切除术是治疗鳞状细胞食管癌同样有效的手术选择。
