胸腹腔镜联合手术与传统开胸手术治疗食管癌的效果及对肺功能的影响比较

Comparison of the efficacy of thoracoscopic and laparoscopic surgery with conventional thoracic surgery on esophageal cancer and its influence on pulmonary function

目的 比较胸腹腔镜联合手术与传统开胸手术治疗食管癌的效果及对肺功能的影响.方法 2010年3月至2016年3月我院收治的94例食管癌患者,根据手术方法不同分为对照组54例和研究组40例.对照组采用传统开胸手术进行治疗,研究组采用胸腹腔镜联合手术进行治疗.比较两组患者手术情况以及肺功能指标.结果 研究组患者手术时间显著长于对照组[（218.1±35.8）min与（192.3±40.1）min,t=3.23,P〈0.05],术中出血量显著少于对照组[（286.4±83.5）ml与（343.7±96.7）ml,t=3.01,P〈0.05],清扫淋巴结数量显著多于对照组[（18.0±5.4）枚与（15.5±4.6）枚,t=2.42,P〈0.05],胸腔引流量显著少于对照组[（650.3±61.3）ml与（1153.5±133.7）ml,t=22.12,P〈0.05],拔出胸管时间显著早于对照组[（5.1±1.3）d与（8.0±1.8）d,t=8.65,P〈0.05],首次排气时间显著早于对照组[（33.2±6.7）h与（40.7±7.3）h,t=5.10,P〈0.05],住院时间显著短于对照组[（13.8±2.8）h与（18.2±3.6）h,t=6.42,P〈0.05].研究组术后并发症4例次,占10.0%;显著低于对照组的15例次（27.8%）,差异有统计学意义（χ2=4.50,P〈0.05）.研究组肺活量实测值占预计值的百分比（VC）、第1秒用力呼气容积占肺活量的百分比（FEV1）及最大通气量实测值占理论预计值的百分比（MVV）均显著高于对照组[VC：（81.5±15.6）%与（42.3±8.1）%,FEV1：（85.7±9.1）%与（43.6±6.8）%,MVV：（76.0±8.9）%与（48.3±7.6）%;t值分别为15.83,25.68,16.24,P均〈0.05].研究组3年生存率45.0%（18/40）,对照组3年生存率44.4%（24/54）,组间比较,差异无统计学意义（χ2=0.01,P〉0.05）.结论 胸腹腔镜联合手术治疗食管癌,具有创伤小、患者恢复快、并发症发生率低、有明显的肺功能保护作用等优势,安全可行.

Objective To compare the effect of thoracoscopic and laparoscopic surgery with conventional thoracic surgery on esophageal cancer and its influence on pulmonary function. Methods Ninety？four patients with esophageal cancer treated in the Second Affiliated Hospital of Chengdu Medical College from March 2010 to March 2016 were selected and were divided into the control group （ 54 cases） and the study group （ 40 cases） according to operation methods. The control group received traditional thoracotomy. The study group received thoracoscopic and laparoscopic surgery. The operation and pulmonary function indexes were compared. Results The operation time of the patients in the study group was significantly longer than that in the control group （ （218. 1±35. 8） min vs. （192. 3±40. 1） min,t=3. 23,P〈0. 05）. Intraoperative blood loss of the patients in the study group was significantly less than that in the control group （ （286. 4±83. 5） ml vs. （343. 7 ±96. 7） ml,t=3. 01,P〈0. 05） . The number of lymph nodes cleared of the patients was significantly higher in the study group （ （18.0±5.4） node vs. （15.5±4.6） node,t=2.42,P〈0.05）.Thoracic drainage of the patients in the study group was significantly less than that in the control group （ （650. 3±61. 3） ml vs. （1153. 5 ±133. 7） ml,t=22. 12,P〈0. 05）. Chest tube pull out time in the study group was significantly earlier than that in the control group （ （5. 1±1. 3） d vs. （8. 0±1. 8） d,t=8. 65,P〈0. 05）. First exhaust time in the study group was significantly earlier than that in the control group （ （33. 2±6. 7） h vs. （40. 7±7. 3） h,t=5. 10,P〈0. 05）. Hospital stay in the study group was significantly shorter than that in the control group （ （ 13. 8 ± 2. 8 ） d vs. （18. 2± 3. 6） d, t=6. 42, P〈0. 05） . Postoperative complications occurred in 4 cases in the study group, accounting for 10%, significantly lower than that in the control group, 15 cases, 27. 8%, the difference was statistically significant （χ2=4. 50,P〈0. 05） . VC,FEV1 and MVV in the study group were significantly higher than those in the control group （ VC：（ 81. 5 ± 15. 6 ）% vs. （ 42. 3 ± 8. 1 ）%;FEV1： （ 85. 7 ± 9. 1 ）% vs. （ 43. 6 ±6. 8）%;MVV：（76. 0±8. 9）% vs. （48. 3±7. 6）%,t=15. 83,25. 68,16. 24,P〈0. 05）. 3？year survival rate of the study group and the control group were 45. 0% （18/40） and 44. 4% （24/54）,respectively. There was no significant difference between the two groups （χ2 = 0. 01, P〉 0. 05 ） . Conclusion Thoracoscopic and laparoscopic surgery for esophageal cancer has the advantages of small trauma,rapid recovery and low incidence of complications and obvious protective effect on pulmonary function. It is safe and feasible.