胸腔镜联合腹腔镜食管癌根治术的临床疗效及对机体应激反应的影响

Clinical Efficacy of Thoracoscopic Combined with Laparoscopic Esophagectomy for Esophageal Cancer and Its Effect on Stress Response

目的探讨胸腔镜联合腹腔镜食管癌根治术的临床疗效及对机体应激反应的影响。方法回顾性分析82例食管癌患者的临床资料,根据手术方式分为腔镜组(41例,行胸腹腔镜下食管癌根治术)和开放组(41例,行传统开放食管癌根治术)。对比2组患者的围手术期指标及相关应激反应指标的差异。结果腔镜组患者的术中出血量、术后引流量、首次排气时间和平均住院时间均少(短)于开放组,手术时间长于开放组,差异具有统计学意义(P<0.05);2组患者淋巴结清扫数目比较,差异无统计学意义(P>0.05)。腔镜组术后并发症发生率明显低于开放组,差异具有统计学意义(P<0.05)。2组患者术后复发率、远处转移率及病死率比较,差异均无统计学意义(P均>0.05)。2组患者术后应激反应指标比较,差异无统计学意义(P>0.05)。结论胸腔镜联合腹腔镜治疗食管癌是安全可行的,具有术中出血少、术后恢复快的优势,且对机体应激反应无明显影响。

Objective To explore the clinical effect of thoracoscopic combined with laparoscopic esophagectomy for esophageal cancer and its effect on stress response.Methods The clinical data of 82 patients with esophageal cancer were retrospectively analyzed.According to the operation methods,they were divided into endoscopic group(41 cases,underwent thoracoscopic and laparoscopic radical esophagectomy)and open group(41 cases,underwent traditional open radical esophagectomy).The differences of perioperative indexes and related stress response indexes between the 2 groups were compared.Results The intraoperative bleeding volume,postoperative drainage volume,first exhaust time and average hospitalization time in endoscopy group were less than those of open group,and the operation time was longer than that in open group,with statistical significance(P<0.05);there was no significant difference in the number of lymph node dissection between the 2 groups(P>0.05).The incidence of complications in laparoscopic group was significantly lower than that of open group(P<0.05).There was no significant difference in recurrence rate,distant metastasis rate and fatality rate between the 2 groups(P>0.05).There was no significant difference in post-operative stress response between the 2 groups(P>0.05).Conclusion Thoracoscopy combined with laparoscopy in the treatment of esophageal cancer is safe and feasible.It has the advantages of less bleeding during operation and faster recovery after operation,but it has no obvious effect on the body's stress response.