胸腹腔镜联合食管癌根治术的手术方法安全性及临床效果分析

Surgical methods,safety and clinical effect of thoracolaparoscopy three-field esophagectomy in treatment of esophageal cancer

目的探讨胸腹腔镜联合手术在食管癌治疗中的手术方法、安全性及临床效果。方法选择接受食管癌根治切除术的患者90例,行胸腹腔镜联合食管癌根治术的40例患者为胸腹腔镜组,行传统左开胸食管癌根治术的50例患者为传统左开胸组,比较分析两组手术方法、安全性及临床效果。结果胸腹腔镜组的术中出血量、胸腔引流量、术后1~3 d胃管总引流量少于传统左开胸组(P<0.05)。胸腹腔镜组的拔除胸管时间、住院时间、首次排气排便时间均短于传统左开胸组(P<0.05),但手术时间长于传统左开胸组(P<0.05)。胸腹腔镜手术组肺部并发症发生率低于传统左开胸组(P<0.05),但吻合口瘘、声带麻痹发生率高于传统左开胸组(P<0.05),而两组乳糜胸、围手术期病死率差异无统计学意义(P>0.05)。结论胸、腹腔镜联合食管癌根治术在技术上安全可行,临床效果显著,但术后相关并发症仍需警惕。

Objective To investigate the safety,surgical methods and clinical effect of thoracolaparoscopic surgery in the treatment of esophageal cancer. Methods The clinical data of 40 patients with esophageal cancer who underwent thoracolaparoscopic surgery treatment from October 2014 to September 2015 were retrospectively analyzed,and 50 patients were given traditional left thoracotomy in the same period. Then the safety,surgical methods and clinical effect of the two groups were compared and analysed. Results Blood loss,thoracic drainage,gastric tube drainage were less in thoracolaparoscopic group than in traditional left thoracotomy group( P < 0. 05). The time of pulling out the chest tube,hospital stay,first flatus and defecation was shorter in thoracolaparoscopic group than in traditional left thoracotomy group( P < 0. 05),but the operative time was longer in thoracolaparoscopic group( P < 0. 05). For postoperative complications,the incidences of anastomotic fistulas and vocal cord paralysis were higher but the incidences of pulmonary complications were lower( P < 0. 05). However,the incidence of chylothorax and perioperative case fatality rate of two groups had no significant differences( P > 0. 05). Conclusion Thoracolaparoscopy three-field esophagectomy is safe and feasible in the treatment of esophageal cancer,but related complications still remain vigilant.