胸腹腔镜联合微创手术在新辅助治疗食管癌中的应用分析

The application of combined thoracoscopic and laparoscopic minimally invasive surgery in esophageal cancer with neoadjuvant therapy

目的探讨胸腹腔镜联合微创治疗新辅助放化疗食管癌的安全性及可行性。方法回顾分析2012年1月-2013年12月在我院进行新辅助放化疗的35例食管癌患者的临床资料，比较常规三切口手术（常规组）与胸腹腔镜联合微创手术（微创组）的手术时程、术中出血、淋巴结清扫情况、术后引流及围手术期并发症。结果常规组（18例）和微创组（17例）的术后引流量及淋巴结清扫数量差异无统计学意义（P〉0．05）；手术时程及术中出血量方面两组差异具有统计学意义（P〈0．05），微创组的手术时程长于开胸组，但术中出血量少于开胸组；两组其他术后观察指标的结果差异无统计学意义（P〉0．05）；术后并发症主要为呼吸功能障碍、吻合口瘘，两组均无术后严重并发症致死。结论胸、腹腔镜联合微创治疗新辅助放化疗食管癌安全可行，值得深入研究并推广应用。

Objective To investigate the safety and feasibility of combined thoracoscopic and laparoscopic minimally invasive surgery for esophageal cancer patients administered with neoadjuvant therapy. Method The records of esophageal cancer patients who received neoadjuvant therapy in our hospital between January 2012 and December 2013 were retrospectively analyzed, and the surgery duration, intraoperative bleeding, lymph node clearance, postoperative drainage and perioperative complications between conventional three-incision esophageetomy and the combined thoraco-scopic and laparoscopic minimally invasive surgery were compared. Result For conventional three-incision esophagectomy group （Conv. group, 18 cases） and minimally invasive surgery group （MIS group, 17 cases） , there was no statis- tical difference in post-operative drainage and lymph node clearance （P〉0.05） ; while operation duration and intra-operative bleeding were statistically different, MIS took longer time in operation, with less intra-operative bleeding. No differences were seen in other postoperative observations （P〉0.05）. The major postoperative complications included dyspnea and anastomotic leak, and there were no death reports. Conclusion Combined thoracoscopic and laparoscopic minimally invasive surgery is safe and feasible for esophageal cancer patients with neoadjuvant therapy and it is worthy of further research and popularization.