胸腹腔镜联合食管癌根治术的临床疗效分析

Analysis of the clinical therapeutic effect of thoracoscopy and laparoscopy combined radical operation for esophageal carcinoma

目的探索胸腹腔镜联合食管癌根治术的临床疗效，以期为临床治疗提供参考和借鉴。方法回顾性分析2010年6月-2017年5月解放军昆明总医院胸外科收治的521例食管癌患者的临床资料。依据手术方式的不同将患者分为试验组（n=276）和对照组（n=245），试验组采用胸腹腔镜联合食管癌根治术，对照组采用食管癌开放手术。比较两组患者术中情况（手术时间、术中出血量等）、术后情况（术后引流量、术后置管时间、术后住院时间等）、术后并发症（肺部感染、吻合口瘘、喉返神经麻痹、乳糜胸、胃排空延迟、胸腔积液、切口感染等）以及术后生存质量[癌症患者生活质量核心量表（QLQ-c30），食管癌患者补充量表（QLQ-OES18）]等指标。计量资料以均数±标准差（x±S）表示，组间采用t检验，计数资料以百分比（％）表示，组间比较采用，检验。结果试验组的手术时间[（238．7±32．4）min]、术后置管时间[（5．7±1．2）d]和术后住院时间[（9．6±2．7）d]等指标均短于对照组[（245．1±34．6）min、（8．7±2．6）d、（1．4±4．6）d]，术中出血量[（198．6±41．2）ml]和术后引流量[（221．7±32．1）ml]均少于对照组[（231．9±43．5）ml、（257．8±38．6）ml]；试验组肺部感染、吻合口瘘和切口感染等发病率低于对照组，QLQ-C30各项评分指标中试验组的情绪功能、躯体功能和总体状况等评分高于对照组，QLQ—OES18各项评分指标中试验组的进食困难、反流、疼痛、食欲减退和咳嗽评分低于对照组，差异具有统计学意义（P〈0．05）。结论胸腹腔镜联合手术与食管癌开放手术相比，在改善术中、术后情况，降低术后并发症发生率，提高术后生存质量等方面更有优势。

[ Abstract ] Objective To explore the clinical therapeutic effect of thoracoscopy and laparoscopy combined radical operation for esophageal carcinoma and provide reference for clinical treatment. Methods The clinical data of five hundred and twenty-one patients with esophageal cancer in Kunming General Hospital of PLA from June 2010 to May 2017 were analyzed retrospectively. The patients were divided into experimental group （ n = 276） and control group （ n = 245 ） according to the type of procedure. The experimental group was treated with thoracoscopy and laparoscopy, and the control group was treated with open esophagectomy. The intra-operative condition （surgery time, intraoperative blood loss）, postoperative condition （postoperative drainage volume, postoperative catheterization time, postoperative hospital stay）, postoperative complications （pulmonary infection, anastomotic fistula, recurrent nerve paralysis, chylothorax, gastric emptying delayed, pleural effusion, incisal infection） and life quality [ quality of life questionnaire C30 （QLQ-C30） version 3. 0 core, quality of life questionnaire-OES18 （QLQ-OES18） ] were compared between the two groups. The measurement data were expressed by （x ± s） and the two group were compared with the t test. The count data were expressed by percentage （ % ） and inter-group comparisons were performed by chi-square test between the two groups. Results The operation time [ （238.7± 32. 4 ） rain vs （245. 1 ± 34.6） mini, period of catheter indwelling [ （5.7 ± 1.2） d vs （8.7 ± 2.6） d] and hospital stay [ （9.6 ± 2.7） d vs （ 11.4 ± 4.6） d] were shorter, the amount of intraoperative bleeding [ （ 198.6 ± 41.2） ml vs （231.9 ± 43.5 ） ml ] and post-operation drainage [ （221.7 ±32. 1 ） ml vs （257.8 ± 38.6） ml] were less, and the morbidity of lung infection, anastomotic fistula and incision infection were lower in the experimental group than in the control group. The scores of emotional function, physical function and overall health status which belong to QLQ-C30 scale were higher anti the scores of difficulty in feeding, reflux, pain, loss of appetite and cough which belong to QLQ-OES18 were lower in the experimental group than in the control group. The differences between the two groups had statistical significance （P 〈 0.05 ）. Conclusion Compared with open esophagectomy, thoracoscopy and laparoscopy combined radical operation for esophageal carcinoma has an advantage in improving the intra-operative and postoperative condition, reducing the postoperative complication rate and enhancing the postoperative life quality.