手术治疗稳定期肺结核并发食管下段癌的效果分析

Analysis on the effect of surgical treatment for stable pulmonary tuberculosis associated with lower esophageal carcinoma

目的探讨手术治疗稳定期肺结核并发食管下段癌的可行性和安全性。方法收集2009年3月至2014年3月泰安市肿瘤（结核病）防治院收治的34例稳定期肺结核并发食管下段癌患者（A组），以及同期310例单纯食管下段癌患者（B组），均行常规食管下段癌手术治疗。回顾性分析在手术时间、出血量、切除率、术后低氧血症、延迟发热、心律失常、肺部并发症、切口不愈、吻合口瘘、手术死亡率、生存率等在2组患者间的差异。采用DPS10．0软件进行统计学分析，计量资料以“x^-±s”表示，采用t检验；计数资料为小样本数据，采用校正y。检验。均以P〈0．05为差异有统计学意义。结果A组患者的手术时间[（3．4±0．4）hl、出血量[（181．0±71．4）ml]、手术根治性切除率（94．1％，32／34）与B组[分别为（3．1±0．4）h、（165．0±80．5）ml、93．5％（290／310）]比较，差异无统计学意义（t=1．77，P=0．055；t=0．73，P=0．241；x^2=0．06，P=0．810）。A组患者术后低氧血症（17．6％，6／34）、手术延迟发热（32．4％，11／34）、肺部并发症（23．5％，8／34）的发生率明显高于B组（分别为6．5％，20／310；16．1％，50／310；10．3％，32／310）（x^2=4．01，P=0．045；x^2=4．47，P=0．034；x^2=3．99，P=0．045）；但心律失常（8．8％，3／34）、切口不愈（2．9％，1／34）、吻合口瘘（5．9％，2／34）、手术死亡率（2．9％，1／34）的发生率与B组（分别为6．1％，19／310；2．9％，9／310；3．9％，12／310；1．0％，3／310）比较，差异无统计学意义（x^2=0．06，P=0．810；x^2=0．28，P=0．599；x^2=0．01，P=0．915；x^2=0．03，P=0．860）。A组1年生存率（94．1％，32／34）、2年生存率（67．6％，23／34）与B组（分别为93．9％，291／310；74．8％，232／310）比较，差异无统计学意义（x^2=0．10，P=0．748；x^2=0．49，P=0．482），但3年生存率A组（20．6％，7／34）明显低于B组（42．9％，133／310）（x^2=5．43，P=0．019）。A组患者术后均未发生肺结核病情进展及播散情况。结论手术治疗稳定期肺结核并发食管下段癌的可行性、安全性较好，未出现肺结核病情进展及播散情况，可作为首选且有效的治疗方式。

Objective To investigate the feasibility and safety of surgical treatment for patients who have sta ble pulmonary tuberculosis associated with lower esophageal carcinoma. Methods The clinical data of surgical treatment for 34 cases of stable pulmonary tuberculosis associated with lower esophageal carcinoma （Group A） and 310 cases of lower esophageal carcinoma alone （Group B） from March 2009 to March 2014 in Taian Tumor （Tuberculosis） Hospital was collected. All the patients received routine surgical treatment for lower esophageal carcinoma. The difference between both groups in operation lasting time, blood loss, resection rate, postoperative hypoxemia, delayed fever, cardiac arrhythmia, pulmonary complications, wound healing, anastomotic leakage, operative mortality and survival rate was retrospectively analyzed. DPS 10.0 was used for statistical analysis. The measurement data was expressed as ＂x^-±s＂, and t test was used. The count data was small sample data, and the corrected x^2 test was used. P〈0.05 was regarded as statistically significant. Results There was no statistically difference （P〉0. 05） between the two groups in operation lasting time （A： （3.4±0. 4） h, B： （3.1±0.4） h. t= 1.77, P=0. 055）, intraoperative blood loss （A： （181.0±71.4） ml, B： （165.0±80.5） ml. t=0.73, P=0. 241） and the resection rate （A： 94.1% （32/34）, B：93.5% （290/310）. x^2=0.06, P=0. 810）. The incidence rate of postoperative hypoxemia （17.6%, 6/34）, surgical delayed fever （32.4%, 11/34） and pulmonary complications （23.5%, 8/34） in Group A was significantly higher than that in Group B （6.5%, 20/310; 16.1%, 50/310; 0.3%, 32/310） （x^2=4.01, P=0.045; x^2=4.47, P=0.034; x^2=3.99, P=0.045）; but there was no statisti-cally difference （P=0. 05） between the two groups in the incidence rate of cardiac arrhythmia （A： 8. 8% （3/34）, B= 6.1%0 （19/310）;x^2=0.06, P=0.810）, difficult healing wound （A： 2.9% （1/34）, B： 2.9% （9/310）; x^2=.28, P=0. 599）, anastomotic leakage rate （A： 5.9% （2/34）, B： 3.9% （12/310） x^2= =0.01, P=0. 915）, and operative mortality （A： 2.9% （1/34）, B： 1.0% （3/310） ;x^2==0. 03, P=0. 860）. There was no significant difference between the two groups in 1-year survival rate （A： 94.1% （32/34）, B： 93.9%（291/310）;x^2= =0.10, P=0. 748） and 2-year survival rate （A： 67.7% （23/34）, B： 74.8% （232/310） ; x^2= =0. 49, P=0. 482）, but the 3-year survival rate in Group A was significantly lower than that in Group B （A： 20.6% （7/34）, B： 42.9% （133/310） ; x^2= = 5.43, P= 0.019）. No postoperative progression and dissemination of tuberculosis were found in Group A. Conclusion The feasibility and safety of surgical treatment for patients who have stable pulmonary tuberculosis associated with lower esophageal carcinoma are good, and there is no progression and dissemination of tuberculosis, suggesting that surgical treatment is still the primary and effective treatment for these patients.