经右胸三切口与左胸两切口入路手术在胸中段食管癌患者中的应用效果研究

Study on the Application Effect of Right Chest Three Incision and Left Chest Two Incision Approaches in Patients with Middle Thoracic Esophageal Cancer

目的比较经右胸三切口与左胸两切口入路手术对胸中段食管癌患者围术期指标及复发转移的影响。方法选择2021年1月—2022年1月呼伦贝尔市人民医院收治的80例拟行手术治疗的胸中段食管癌患者为研究对象,经右胸三切口入路手术的40例患者纳入观察组,经左胸两切口入路手术的40例患者纳入对照组。比较两组围术期指标及复发转移情况。结果观察组淋巴清扫数目、术中失血量均多于对照组,组间差异有统计学意义(P<0.05);两组手术时间、留置胸管时间比较,组间差异无统计学意义(P>0.05);观察组术后疼痛视觉模拟评分高于对照组,术后住院时间长于对照组,组间差异有统计学意义(P<0.05)。术后第7天,观察组血清中缺氧诱导因子-α、血管内皮生长因子及血管内皮生长因子的受体水平均低于对照组,组间差异有统计学意义(P<0.05)。两组术后并发症发生率比较,差异无统计学意义(P>0.05)。观察组2年复发转移率为20.00%,低于对照组的42.50%,差异有统计学意义(P<0.05)。结论在治疗胸中段食管癌患者时,经右胸三切口入路手术相较于左胸两切口入路手术能够增加淋巴清扫数目,降低术后复发转移风险,但可能会增加术中失血和术后疼痛。

Objective To compare the effects of right chest three incision and left chest two incision approaches on perioperative indicators and recurrence and metastasis in patients with middle thoracic esophageal cancer.Methods Eighty patients with mid thoracic esophageal cancer who were admitted to Hulunbuir People's Hospital from January 2021 to January 2022 and planned to undergo surgical treatment were selected as the study subjects.Forty patients who underwent surgery through the right chest three incision approach were included in the observation group,while 40 patients who underwent surgery through the left chest two incision approach were included in the control group.The perioperative indicators and recurrence metastasis were compared between the two groups.Results The number of lymph node dissection and intraoperative blood loss in the observation group were higher than those in the control group,and the differences between the groups were statistically significant(P<0.05).There was no statistically significant difference between the two groups in terms of surgical time and indwelling chest tube time(P>0.05).The postoperative pain Visual Analogue Scale score of the observation group was higher than that of the control group,and the postoperative hospitalization time was shorter than that of the control group,and the differences between the groups were statistically significant(P<0.05).On the 7th day after surgery,the levels of hypoxia inducible factor alpha,vascular endothelial growth factor,and vascular endothelial growth factor receptor in the serum of the observation group were lower than those of the control group,and the differences between the groups were statistically significant(P<0.05).There was no statistically significant difference in the incidence of postoperative complications between the two groups(P>0.05).The 2-year recurrence and metastasis rate in the observation group was 20.00%,which was lower than the control group's 42.50%,and the difference was statistically significant(P<0.05).Conclusion Compared to the left chest two incision approach,the right chest three incision approach can increase the number of lymph node clearance and reduce the risk of postoperative recurrence and metastasis in the treatment of middle thoracic esophageal cancer patients.However,it may increase intraoperative blood loss and postoperative pain.