胸、腹腔镜联合手术治疗食管癌的临床对比

Comparison between Thoracoscopy Combined with Laparoscopy and Open Surgery for Esophageal Carcinoma

目的探讨胸、腹腔镜联合手术治疗食管癌的应用价值。方法回顾分析2007年1月～2011年4月113例食管癌的临床资料,其中胸、腹腔镜联合手术62例(腔镜组),行右胸、上腹二切口,或右胸、上腹、左颈三切口治疗51例(开胸组)。比较2组手术时间、术中出血量、淋巴结清扫数目、术后住院时间、并发症发生率、术后病理、住院费用。结果 2组肿块均无明显外侵,均为T3期以下病变。腔镜组和开胸组手术时间分别为(310.5±38.0)min、(301.0±34.7)min(t=1.377,P=0.171),术中出血量为(200.8±61.1)ml、(210.8±49.3)ml(t=-0.941,P=0.349),淋巴结清扫数目为12.4±2.8、13.2±2.5(t=-1.461,P=0.147),术后住院时间为(11.9±2.0)d、(12.5±2.1)d(t=-1.553,P=0.123),并发症发生率为19.4%(12/62)、25.5%(13/51)(χ2=0.611,P=0.434),2组差异均无显著性。腔镜组住院费用明显高于开胸组[(4.5±0.3)万元vs.(3.4±0.3)万元,t=17.790,P=0.000]。结论针对T3期以下的食管癌,胸、腹腔镜联合手术能达到完全的肿瘤切除与淋巴结清扫,手术时间未明显延长,临床操作安全可行,值得临床推广应用。

Objective To discuss the value of thoracoscopy combined with laparoscopy for esophageal carcinoma. Methods The clinical data of 113 cases with esophageal carcinoma, who received tboracoscopy combined with laparoseopy （Endoscopic group, n =62）, or open surgery （thoracotomic group, n =51 ） in our hospital during January 2007 through April 2011, were retrospectively analyzed. In the thoracotomic group, two incisions were made on the right chest, upper abdomen, with or without a third one on the left neck. The operation time, intraoperative blood loss, number of removed lymph nodes, postoperative hospital stay, rate of complications, postoperative pathological findings, and hospitalization cost were compared between the two groups. Results No obvious invasion was detected in both the groups, postoperative pathological examination showed T3 or lower stage. No significant difference was observed in operation time, intraoperative blood loss, number of removed lymph nodes, postoperative hospital stay and rate of complications [ endoscopic group vs. thoracotomic group： （310.5 ± 38.0） min vs. （301.0 ± 34.7） min, t = 1. 377, P=O. 171; （200.8±61.1） mlvs. （210.8±49.3） ml, t= -0.941, P=0.349; 12.4±2.8 vs. 13.2±2.5, t= -1.461, P= 0.147; （11.9 ±2.0） dvs. （12.5 ±2.1） d, t= -1.553,P=0.123;and19.4% （12/62） vs. 25.5% （13/51）,X2=0.611, P= 0.434]. However, the hospitalization cost of the endoscopic group was significantly higher than that in the thoracotomie group [（4.5±0.3） xlO4 RMB vs. （3.4 ±0.3） ×10^4 RMB, t=17.790,P=0.000]. Conclusions For esophageal carcinoma at T3 or lower stage, thoraeoscopy combined with laparoseopy can remove the tumor and lymph nodes thoroughly without prolonging operation time. We recommend it as a routine for its safety and effectiveness.