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目的：探讨应用上腹右胸两切口治疗胸段食管癌的临床经验。方法：回顾分析1990年1月-2005年12月采用经上腹右胸两切口(Ivor-Lewis术式)治疗676例胸段食管癌患者的临床资料。结果：全组并发率为12．7%,肺部并发症占第1位(占30．2%),吻合口瘘4例,其中1例为胃壁坏死或者穿孔,均经保守治愈。死亡1例,系胸穿致严重窒性心律失常致死。本组1、3、5年生存率分别为86．1%、61．2%和45．2%,无淋巴结转移的5年生存率为62．2%；有淋巴结转移的5年生存率为30．2%。结论：上腹、右胸两切口食管癌切除术具有良好的胸腹腔显露。淋巴结清扫彻底,尤其对右侧最上纵隔喉返神经旁淋巴结清扫方便有利。且操作方便,吻合可靠,故此术式为治疗胸段食管癌较为理想的术式。
Objective: To explore the clinical experience of the treatment of thoracic esophageal cancer with two incisions in the upper abdomen and right chest. METHODS: The clinical data of 676 patients with thoracic esophageal cancer who underwent epistaxis and right thoracic incisions (Ivor-Lewis operation) from January 1990 to December 2005 were retrospectively analyzed. RESULTS: The overall complication rate was 12.7%, pulmonary complications accounted for the first place (30.2%), and anastomotic fistula occurred in 4 cases. One case was gastric wall necrosis or perforation. All were conservatively cured. One patient died of death and was severely convulsive of arrhythmia due to thoracentesis. The 1-, 3-, and 5-year survival rates for this group were 86.1%, 61.2%, and 45.2%, respectively. The 5-year survival rate without lymph node metastasis was 62.2%; the 5-year survival rate with lymph node metastasis was 30.2%. Conclusion: The abdomen and right thoracic incision esophagectomy has good thoracic and abdominal cavity exposure. Thorough lymph node dissection, especially for the right uppermost mediastinal recurrent laryngeal lymph node dissection is convenient and beneficial. The operation is convenient and reliable, so it is an ideal operation for the treatment of thoracic esophageal cancer.