微创McKeown食管癌根治术联合新辅助化疗治疗局部晚期食管癌的近期和远期疗效分析

Analysis of short and long-term curative effect of minimally invasive McKeown esophagectomy combined with neoadjuvant chemotherapy for locally advanced esophageal carcinoma

目的探讨微创McKeown食管癌根治术联合新辅助化疗治疗局部晚期食管癌的近期和远期疗效。方法依据随机数字表法将84例局部晚期食管癌患者分为研究组和对照组,每组42例。对照组患者采用微创McKeown食管癌根治术,研究组患者采用微创McKeown食管癌根治术联合新辅助化疗。比较两组患者的近期疗效、围手术期指标(术中出血量、手术时间、住院时间、淋巴结清扫个数)、术后并发症发生情况、治疗前后的肿瘤标志物[细胞角质蛋白19片段抗原21-1(CYFRA21-1)、糖类抗原125(CA125)、癌胚抗原(CEA)]水平以及远期疗效(1年生存率、远处转移率及局部复发率)。结果研究组患者的近期疗效优于对照组患者,差异有统计学意义(P﹤0.05)。两组患者的术中出血量、手术时间、住院时间、淋巴结清扫个数及术后并发症总发生率比较,差异均无统计学意义(P﹥0.05)。治疗后,两组患者的血清CYFRA21-1、CA125、CEA水平均较本组治疗前降低,且研究组患者的血清CYFRA21-1、CA125、CEA水平均低于对照组患者,差异均有统计学意义(P﹤0.05)。研究组患者的1年生存率高于对照组患者,1年远处转移率和局部复发率均低于对照组患者,差异均有统计学意义(P﹤0.05)。结论微创McKeown食管癌根治术联合新辅助化疗治疗局部晚期食管癌可有效提高患者的近期和远期疗效,值得临床推广。

Objective To investigate the short and long-term curative effect of minimally invasive Mc Keown esophagectomy combined with neoadjuvant chemotherapy for locally advanced esophageal carcinoma. Method A total of 84 patients with locally advanced esophageal carcinoma were included in the research and were randomly divided into study group and control group using a random number table, with 42 cases in each group. Patients in control group were treated with minimally invasive McKeown esophagectomy, patients in study group were administered with neoadjuvant chemotherapy in addition to minimally invasive McKeown esophagectomy. The short-term curative effects, perioperative surgical indicators(intraoperative blood loss, operative time, length of hospital stay, number of resected lymph nodes), incidence of postoperative complications, as well as the tumor marker level before and after treatment [including cyto-keratin19 fragment antigen 21-1(CYFRA21-1), carbohydrate antigen 125(CA125), and carcinoembryonic antigen(CEA)], and long-term effect(1-year survival rate, distant metastasis rate and local recurrence rate) were compared between the two groups. Result Compared with the control group, the short-term efficacy observed in study group was significantly better(P<0.05), while there were no significant differences regarding the intraoperative blood loss, operative time, length of hospital stay, the number of lymph nodes dissected and incidence of postoperative complication between study group and control group(P>0.05). After treatment, the levels of serum CYFRA21-1, CA125, CEA in both groups decreased significantly, moreover, the serum levels of CYFRA21-1, CA125, and CEA in study group were significantly lower compared to control group(P<0.05). The 1-year survival rate in the study group was significantly higher than that in the control group,and the 1-year distant metastasis rate and local recurrence rate were significantly lower in study group than in control group(P<0.05). Conclusion Minimally invasive McKeown esophagectomy combined with neoadjuvant chemotherapy in the treatment of locally advanced esophageal carcinoma effectively improves the short-and long-term outcomes.