食管癌根治术中采用腹腔镜辅助胃游离与传统两切口的优势比较

Advantages comparison of laparoscopic assisted gastric dissection and traditional dual-incision in esophageal carcinoma radical surgery

目的探讨食管癌根治术中采用腹腔镜辅助胃游离的优势。方法选取2012年8月至2017年8月该院肿瘤外科收治的食管癌根治术患者80例,按随机双盲对照选择手术方式分为腔镜组和对照组,每组40例。对照组采用传统两切口手术方式,腔镜组采用腹腔镜辅助胃游离联合右侧开胸小切口手术方式。所有手术均由同一组手术人员完成。比较两组患者手术时间、术中出血量、术后第1天腹腔引流量、术后腹腔引流管拔管时间、重症监护病房观察时间、术后住院时间、淋巴结清扫数目、术后病检阳性淋巴结数目、并发症发生率,以及术后12、24、48 h疼痛视觉模拟评分等。结果腔镜组患者术中出血量、术后第1天腹腔引流量均明显少于对照组,术后腹腔引流管拔管时间明显早于对照组,术后重症监护病房观察时间、术后住院时间均明显短于对照组,术后并发症发生率,以及术后12、24 h疼痛视觉模拟评分均明显低于对照组,差异均有统计学意义(P<0.05)。两组患者术中淋巴结清扫数目比较,差异无统计学意义(P>0.05)。结论在食管癌根治术中采用腹腔镜辅助胃游离的手术方式,与传统两切口方式比较,手术创伤明显减少,其安全性与有效性均得到了验证,具有微创效应。

Objective To explore the advantages of laparoscopic assisted gastric dissection in radical operation of esophageal carcinoma. Methods 80 patients with esophageal cancer treated by thoracic surgery in Department of Oncology Surgery of the First Affiliated Hospital of Bengbu Medical College from August 2012 to August 2017 were selected and divided into laparoscopic group and control group according to the double-blind randomized controlled trial,40 cases in each group.The control group was treated with traditional dual-incision surgery,while the endoscopic group was treated by laparoscopic assisted gastric dissection combined with right open thoracotomy. All the operations were performed by the same surgeons. The operation time,intraoperative blood loss,drainage time of the first day after operation,postoperative extubation time,ICU observation time,postoperative hospital stays,the number of lymph node dissection,the number of positive lymph nodes,complications rate and the Visual Analogue Seale（VAS）scores at 12,24,48 h after surgery were compared between the two groups. Results The intraoperative blood loss,drainage time of the first day after operation,postoperative extubation time,ICU observation time,postoperative hospital stays,complications rate and VAS scores at 12,24,48 h after surgery in the laparoscopic group were obviously shorter than those in the control group,and the difference had statistical significance（P〈0.05）. There was no statistically significant difference on the number of lymph node dissection between the two groups（P〉0.05）. Conclusion In the radical operation of esophageal carcinoma,the surgical trauma of laparoscopic assisted gastric dissection is significantly reduced compared with the traditional dual-incision methods,and the safety and efficacy are verified,moreover the advantage ofminimally invasive is obvious .