胸腹腔镜在肥胖食管癌患者根治术中应用效果

Clinical Analysis of the Effect of Thoracoscopic Laparoscopic Treatment on Patients with high BMI Esophageal Cancer

目的:探讨胸腹腔镜在肥胖患者中行食管癌根治术的临床效果。方法:收集120例T1-3N0-1M0期肥胖(BMI≥28kg/m^2)食管癌患者为研究对象,按照患者意愿选择术式,入胸腹腔镜(TLE)组60例为观察组,胸腔镜联合开腹组(TOE)60例为对照组,手术方法均采取McKeown术式。观察2组患者的腹部手术时间、出血量、淋巴结清扫数目、术后排气时间以及围手术期并发症发生率。结果:2组患者术中均无死亡事件发生以及中转开腹。与对照组比较,观察组腹部操作失血量[(17.50±8.62)mLvs(47.89±13.45)mL]和手术时间[(43.28±11.43)minvs(61.92±15.23)min]少于对照组,术后排气时间[(3.06±0.80)dvs(3.83±0.62)d]和下床活动时间[(1.56±0.42)dvs(2.22±0.60)d]短于对照组(P<0.05),观察组切口并发症发生率(13.33%)低于对照组(41.67%)(P<0.05),2组肺部并发症比较差异无统计学意义。结论:腹腔镜在肥胖食管癌患者根治术中可显著降低切口并发症发生率。

Objective:To investigate the effect of laparoscopy in esophageal cancer patients with high body mass index. Methods: A total of 120 patients with T1-3N0-1M0 were divided into the observation group( n =60) and the control group( n =60). The procedure was chosen according to the patients’ wishes. Patients in observation group underwent thoracoscopy combined laparoscopy esophagectomy (TLE) and the control group underwent thoracoscopy combined open laparotomy esophagectomy (TOE). Clinical characteristics and perioperative outcomes such as abdominal operation time,the amount of blood loss,mean number of dissected abdominal lymph nodes,anus exhaust time and postoperative complications were compared between the two groups. Results: There were no surgery related postoperative deaths occurred and conversion to open surgery in the two groups. Compared with TOE group,TLE group had less amount of blood loss[(17.50±8.62) mL vs (47.89±13.45) mL],abdominal operation time [(43.28±11.43) min vs (61.92±15.23) min],the postoperative bowl function recovery time [(3.06±0.80) d vs (3.83±0.62) d] and the operative ambulatory time [(1.56±0.42) d vs (2.22±0.60) d,( P <0.05)]. The rate of incision compliciations in TLE was significant lower than that in TOE(13.33% vs 41.67%)( P <0.05). Meanwhile,no significant difference were observed in terms of PPC between the two groups. Conclusion: Compared with the open laparotomy,laparoscopy can significantly reduce the incidence of incision complications in patients with high BMI esophageal cancer. It is safe and reliable and worthy of clinical promotion.