腹腔镜在贲门癌切除、食管胃吻合术上的临床应用

Clinical Application of Laparoscopy in Resection of Cardiac Carcinoma and Esophagogastro-anastomosis

目的:探讨腹腔镜在贲门癌切除、食管胃吻合术上的临床应用。方法:选取2015年1月-2017年6月期间于本院胸外科就诊并住院接受贲门癌腹腔镜下手术根治治疗的30例贲门癌患者作为观察组。另外选取同期接受开放性手术的30例贲门癌患者作为对照组。观察两组手术后并发症发生率以及手术时间、住院时间、术中出血量以及胃肠道恢复时间。结果:30例接受腹腔镜手术的贲门癌患者中,27例成功完成腹腔镜下肿瘤根治手术,3例出现中转开腹。观察组手术时间为(236±49)min,术中出血量为(182.7±18.4)m L,胃肠道恢复时间为(4.6±1.2)d,术后住院时间为(10.4±3.7)d,均明显低于对照组的(263±48)min、(197.2±19.8)m L、(5.7±1.3)d、(12.5±3.9)d,差异均有统计学意义(P<0.05)。观察组共有4例患者出现手术相关并发症,其中2例手术吻合口瘘,1例吻合口出血,1例切口感染,其并发症发生率与对照组比较,差异均无统计学意义(P>0.05)。所有出现并发症的患者均经对症治疗和支持治疗后好转。所有患者术后均随访半年,无肿瘤复发和转移现象。结论:腹腔镜下进行贲门癌切除术和食管胃吻合术,具有切口小、出血少、恢复快、并发症发生率低等优点,该手术方式安全、有效,能够达到开腹或开胸肿瘤切除的效果,值得临床推广和应用。

Objective:To investigate the clinical application of laparoscopy in resection of cardiac carcinoma and esophagogastro-anastomosis.Method:A total of 30 patients with cardiac carcinoma treated from January 2015 to June 2017 in department of thoracic surgery in our hospital were received the laparoscopic resection of cardiac carcinoma as observation group.Another 30 patients with cardiac carcinoma were received open resection of cardiac carcinoma at the same period in our hospital as control group.The incidence of postoperative complications,operation time,hospitalization time,intraoperative bleeding volume and gastrointestinal recovery time were observed between the two groups.Result:30 patients with cardiac cancer undergone laparoscopic surgery,27 cases were successfully finished the laparoscopic radical tumor resection surgery and 3 cases were converted to laparotomy.The operation time was(236±49)min and intraoperative bleeding volume was(182.7±18.4)mL,the recovery time of gastrointestinal tract was(4.6±1.2)d,the hospitalization time was(10.4±3.7)d in the observation group,which were significantly lower than those in the control group,the differences were statistically significant(P<0.05).In the observation group,there were 4 cases of operative complications,2 cases of anastomotic fistula,1 case of anastomotic hemorrhage and 1 case of incision infection.There was no significant difference in the incidence of complications between the observation group and the control group(P>0.05).All the patients were improved with symptomatic treatment and supportive care.After 6 months of follow-up visit,no relapsed and metastasis cases were appeared.Conclusion:The laparoscopic resection of cardiac carcinoma and esophagogastro-anastomosis is a safe and feasible procedure with a small incision,less bleeding,rapid recovery,the low incidence of complications.It can achieve the effect of opening abdomen or opening chest tumor resection and is worthy of clinical promotion and application.