胸腹联合腔镜与开放食管癌根治术围手术期并发症及临床疗效分析

Comparative Study of Perioperative Complications and Clinical Effect between Thoracoscopic-Laparoscopic Esophagectomy and Open Procedure

目的探讨胸腹联合腔镜食管癌根治术的围手术期并发症和临床疗效。方法回顾性分析2015年1月至2018年5月在我科行胸腹联合腔镜食管癌根治术(腔镜组)及开放三切口食管癌根治术(开放组)的248例临床资料,记录腔镜组与开放组的手术时间、术中出血量、清扫淋巴结数目、术后疼痛评分、术后下床活动时间、术后住院时间、术后并发症,比较两组并发症发生情况及临床效果。结果与开放组相比,腔镜组在术中出血量、清扫淋巴结数目、术后疼痛评分、术后下床活动时间、肺部感染方面,差异有统计学意义(均P<0.05);在手术时间、术后住院时间、二次开胸、术后转入ICU、吻合口瘘、乳糜胸、静脉血栓、心律失常、脑血管疾病发生等差异无统计学意义(均P>0.05)。结论与开放手术比较,胸腹联合腔镜食管癌手术安全,可减少术中出血量、减轻术后疼痛、缩短术后下床活动时间、降低肺部感染的发生率,在清扫淋巴结方面更有优势。

Objective To explore the perioperative complications and clinical effect in thoracoscopic-laparoscopic esophagectomy.Methods From January 2015 to May 2018,248 patients with esophageal cancer underwent thoracoscopic-laparoscopic esophagectomy(endoscopy group)and open thoracic esophagectomy(open group)in our department were retrospectively analyzed.Operation time,intraoperative blood loss,number of lymph nodes dissected,postoperative pain score,postoperative off-bed time,postoperative hospital stay and postoperative complications were recorded between the endoscopy group and the open group.Postoperative complications and clinical effect were compared between the two groups.Results Compared with the open group,the endoscopy group in intraoperative blood loss,cleaning the number of lymph nodes,postoperative pain score,postoperative activity off-bed time,lung infection,the differences were statistical significance(all P<0.05).No statistical significance was found in operation time,postoperative hospital stay,secondary thoracotomy,transferred to the ICU after operation,anastomotic fistula,chylothorax,venous thrombosis,arrhythmia,the respect such as cerebrovascular disease between the two groups(all P>0.05).Conclusion Compared with the open surgery,the thoracoscopic-laparoscopic esophagectomy is safe,which can reduce intraoperative blood loss,postoperative pain,the incidence of lung infection and shorten the time of postoperative activity out of bed.It has more advantages in cleaning lymph nodes than open surgery.