目的:比较经胸、经左胸腹行下段食管癌根治手术的优缺点，探讨淋巴结清扫的最佳手术径路。方法:回顾性分析2000年1月至2005年1月中山大学附属第一医院心胸外科经胸（96例）和胃肠外科经左胸腹入路（117例）行下段食管癌根治术的临床资料， 比较二组的胸、腹淋巴结清扫数、各区域淋巴结转移度、手术时间、出血量、围手术期死亡率、术后并发症发生率、术后平均恢复时间、生存率。结果:经左胸腹组和经胸组在上纵隔及No1、2、3、4和No7、8、9、11的淋巴结转移度比较，二组差异有统计学意义(P<0.05)；围手术期死亡率、手术时间、出血量、并发症发生率、术后平均恢复时间、生存率， 二组比较差异均无统计学意义(P>0.05) 。结论:下段食管癌根治术经胸入路对上纵隔淋巴结清扫有优势，而经左胸腹入路对腹腔淋巴结清扫有优势。

Objective:To compare 2 surgical approaches for radical esophagectomy and discuss which is a better operative pathway of lymphadenectomy. Methods:Clinical data of 96 patients of thoracic incision and 117 of left abdominothoracic incision with squamous cell carcinoma of the lower esophagus, who underwent radical esophagectomy from Jan 2000 to Jan 2005 in the first affiliated hospital of Sun Yetsan Universtiy,were analyzed retrospectively. Compared was made on number of lymph node resected, regional lymph node metastasis ratio,perioperative mortality,operation time,bleeding volume,surgical complication rate,postoperative hospital stay,median survival period between the 2 groups. Results:There was significant difference in superior mediastinum,and lymph node of the 1st,2nd group abdomen between 2 groups (P<0.05),but there were no significant difference between 2 groups (P>0.05) in the perioperative mortality,operation time,bleeding volume,surgical complication rate,postoperative hospital days,survival rate. Conclusion:Left thoracic incision is more effective on lymphadenectomy of superior mediastinum,Whereas abdominothoracic incision shows more effective on lymphadenectomy of abdominal region.