胸腔镜联合腹腔镜辅助下Ⅱ、Ⅲ期食管癌切除二野淋巴结清扫临床研究

A Clinical Study of StageⅡ-Ⅲ Esophageal Carcinoma Resection Combined with Two-field Lymph Node Dissection Assisted by Thoracoscopy and Laparoscopy

目的通过对胸腔镜联合腹腔镜辅助下与传统开放三切口这两种手术方式在Ⅱ、Ⅲ期食管癌行切除+二野淋巴结清扫中的临床效果对比,研究分析胸腔镜联合腹腔镜辅助下方法的治疗优势,以期为治疗Ⅱ、Ⅲ期食管癌行切除+二野淋巴结清扫患者提供更好的途径。方法回顾性分析2012年1月至2016年7月在本院行食管癌切除+二野淋巴结清扫的Ⅱ、Ⅲ期食管癌患者112例,按手术方式分为对照组(58例),试验组(54例),对照组行传统开放三切口食管癌切除术,试验组行胸腔镜联合腹腔镜辅助下切除术,对比分析试验组、对照组患者性别、年龄、病史、是否吸烟、手术时间、出血量、清扫淋巴结数目、术后住院时间、术后并发症及炎症细胞因子浓度变化。结果试验组、对照组患者病史、是否吸烟等一般资料差异无统计学意义(P>0.05);试验组手术时间(278±45)min、出血量(218±127)mL均少于对照组(291±39)min、(241±136)mL,差异有统计学意义(P<0.05);试验组清扫淋巴结数目(22.28±5.9)个高于对照组(20.67±5.8)个,差异有统计学意义(P<0.05);两组术后住院时间差异无统计学意义(P>0.05);试验组术后出现肺部感染(20.4%)、声音嘶哑(11.1%)及心律失常(3.7%)比率均小于对照组(38.1%)、(22.4%)、(10.3%),差异有统计学意义(P<0.05);两组出血、胸腔积液、动静脉血栓等出现比例差异无统计学意义(P>0.05);术后试验组IL-6、IL-10、TNF-α因子浓度(2.13±1.25)pg/mL、(0.55±0.42)pg/mL、(1.63±0.85)ng/mL较对照组(2.96±1.64)pg/mL、(0.78±0.53)pg/mL、(2.67±1.45)ng/mL相比,差异有统计学意义(P<0.05)。结论胸腔镜联合腹腔镜辅助下Ⅱ、Ⅲ期食管癌切除+二野淋巴结清扫术较传统手术有较为明显的微创优势,术后并发症发生率也少于传统手术,可以在临床上推广应用。

Objective Through clinical effect comparison of thoracoscopy and laparoscopy-assisted operation and tradi- tional open three-incision operation in the dissection of stage Ⅱ-Ⅲ esophageal carcinoma and two-field lymph node, the superiority of thoracoscopy and laparoscopy-assisted operation was study and analyzed,in order to provide better approach for stage Ⅱ-Ⅲ esopha- geal carcinoma resection and two-field lymph node dissection. Methods 112 cases of stage Ⅱ-Ⅲ esophageal carcinoma patients who underwent esophageal carcinoma resection and two-field lymph node dissection in our hospital during January- 2012 to July 2016 were retrospectively analyzed. They were divided into control group of 58 cases and experimental group of 54 cases according to operation methods patients in the control group underwent traditional open three-incision esophageal carcinoma resection, while patients in the experimental group underwent thoracoscopy and laparoscopy-assisted resection. The following characteristics of the two groups were compared ： 1. patients gender, age, medical history- and smoking or not ;2. operation time, bleeding amount, number of lymph nodes dis- sected and length of hospitalization after operation ; 3. postoperative complications such as bleeding, pulmonary- infection, hoarseness, pleural effusion, cardiac arrhythmia, arteriovenous thrombosis and so on ;4. the concentration changes of inflammatory cytokines IL-6, IL-8, IL-10,TNF-α before and after operation. Results General information of patients in the two groups, such as medical history-, smoking or not and so on, showed no statistically significant difference （ P 〉 0. 05 ）. The operation time was （ 278 ±45 ） rain and the blood loss was（218 ±127）mL in experimental group, both lower than control group,whose operation time was（291 ± 39）min and blood loss was （241 ±136 ）mL, the difference being statistically significant（ P 〈 0. 05 ）. As for the number of lymph nodes dissected, （22. 28 ± 5.9 ）of experimental group was higher than（ 20. 67 ± 5.8 ）of control group, the difference being statistically significant（ P 〈 0. 05）. The difference between the two groups in length of hospitalization after operation showed no statistical significance （ P 〉 0. 05 ）. Incidences of postoperative pulmonary- infection （ 20. 4 % ）, hoarseness （ 11.1% ） and arrhythmia （ 3.7 % ） in experimental group were all lower than those （38. 1%, 22. 4 % and 10. 3 %, respectively） of control group, the difference being statistically significant （P 〈 0. 05 ）. The difference between the two groups in rates of hemorrhage, pleural effusion and arteriovenous thrombosis showed no statistical significance （ P 〉 0. 05 ）. After operation, concentration of IL-6, IL-10 and TNF-α in experimental group as （ 2. 13 ±1.25 ） pg/mL, （0. 55 ±0. 42） pg/mL and （ 1.63 ±0. 85 ） ng/mL,were all lower than those of control group as （2. 96 ± 1.64） pg/mL, （ 0. 78 ±0. 53 ） pg/mL and （2. 67 ± 1.45 ） ng/mL, the difference being statistically significant （ P 〈 0. 05 ）. Conclusion Compared with traditional operation, stage Ⅱ-Ⅲ esophageal carcinoma resection combined with two-field lymph node dissection assisted by thoracoseopy and laparoseopy has the obvious advantage of minimal invasion and lower incidence of postoperative complications ,worthy of popularization in clinical practice.