胸腔镜联合腹腔镜治疗食管癌的临床效果观察

Clinical effect observation of thoracoscopy combined with laparoscopy in the treatment of esophageal cancer

目的探讨胸腔镜联合腹腔镜治疗食管癌的临床效果。方法选择2011年5月-2014年5月在重庆市江津区中心医院（以下简称“我院”）住院行手术治疗的85例食管癌患者为观察组，另选同期在我院手术治疗的食管癌患者85例为对照组。观察组给予胸腔镜联合腹腔镜手术，对照组采用开胸三切口食管癌根治术，比较两组总手术时间、总出血量、清扫淋巴结数量、胸腔引流量、术后住院时间、并发症发生情况。对两组患者进行随访，统计患者总生存率（OS）。结果观察组总手术时间[（295±56）min]、总出血量[（170±14）mL]、清扫淋巴结数量[（11．9±4．1）枚]、胸腔引流量[（2100±107）mL]、术后住院时间[（14．3±2．8）d]、并发症发生率[11．8％（10／85）]与对照组[（217±49）min、（390±78）mL、（8．1±3．4）枚、（2860±131）mL、（18．0±3．2）a、37．6％（32／85）]比较，差异有统计学意义（P〈0．05或P〈0．01）。观察组患者随访6～24个月，死亡16例，0S为81．2％（69／85）；对照组患者死亡18例，Os为78．8％（67／85），经Log-rank检验，差异无统计学意义（P〉0．05）。结论胸腔镜联合腹腔镜行食管癌根治手术在技术操作上是安全、可行的，近期手术效果与传统术式无差别。

Objective To investigate clinical effect of thoracoscopy combined with laparoscopy in the treatment of esophageal cancer. Methods 85 cases of esophageal cancer in Central Hospital of Jiangjin District in Chongqing City （＂our hospital＂ for short） from May 2011 to May 2014 were selected as observation group, 85 cases of esophageal cancer in our hospital at the same time were chose as control group. Patients in observation group were treated with thoracoscopy combined with laparoscopy; patients in control group were treated with three incision thoracotomy esophageal cancer radical prostatectomy. The total operation time, total blood loss, lymph node cleaning number, amount of thoracic cavity drainage, postoperative length of stay, complication occurrence between two groups were compared. Two groups were follow-up visited, the overall survival （OS） was measured. Results The differences of total operation time, total blood loss, lymph node cleaning number, amount of thoracic cavity drainage, postoperative length of stay, complication occurrence rate in observation group [（295±56） rain, （170±14） mL, （11.9±4.1） nodes, （2100±107） mL, （14.3±2.8） d, 11.8% （10/85）] and control group [（217±49） min, （390±78） mL, （8.1±3.4） nodes, （2860±131） mL, （18.0±3.2） d, 37.6% （32/85）] were statistically significant （P 〈 0.05 or P 〈 0.01）. Patients in observation group were follow-up visited for 6- 24 months, 16 cases of death were found, the OS was 81.2% （69/85）; 18 cases of death were found in control group, the OS was 78.8% （67/85）, the difference was not statistically significant （P 〉 0.05） according to Log-rank test. Conclusion Thoracoscopy combined with laparoscopy in the treatment of esophageal cancer is safe and feasible, it has no difference with traditional surgery in recent surgery efficacy.