腹腔镜联合食管癌根治术与开放手术对围术期效果和术后生活质量的影响

Effect of Laparoscopic Combined with Esophageal Cancer Radical Operation and Open Surgery on Perioperative Outcome and Postoperative Quality of Life

目的探讨腹腔镜联合食管癌根治术与开放手术对围术期效果和术后生活质量的影响。方法回顾性分析2015年1月—2018年10月该院收治的138例食管癌患者临床资料,按治疗方式不同分为两组,研究组80例,对照组58例。研究组行胸腔镜联合腹腔镜食管癌根治术,对照组行胸腔镜加开腹手术。比较两组围术期效果、术后并发症发生情况及生活质量。结果对照组淋巴结清扫数量为(14.08±5.79)个,与研究组(13.90±4.62)个相比,差异无统计学意义(t=0.203,P=0.840);研究组术中失血量、住院时间、术后带管时间、手术用时为(185.34±179.59)mL、(12.19±4.88)d、(9.88±5.84)d、(351.42±63.78)min,对照组为(288.18±120.01)mL、(15.82±4.21)d、(14.09±5.76)d、(313.17±56.42)min,差异有统计学意义(t=4.259、4.465、4.204、3.648,P=0.000);研究组肺炎、吻合口瘘、胃排空障碍发生率为5.00%、6.25%、5.00%,低于对照组的29.31%、20.69%、24.14%,差异有统计学意义(χ^2=15.402、6.491、10.858,P=0.000、0.011、0.001);两组社会功能评分对比,差异无统计学意义(P>0.05),研究组躯体功能、总健康状况、角色功能评分高于对照组,疲倦、疼痛、咳嗽困难、呼吸困难评分低于对照组,差异有统计学意义(P<0.05)。结论腹腔镜联合食管癌根治术治疗效果与开放手术相当,且具有创伤小、恢复快、并发症发生率低等优势,可提高患者术后生活质量。

Objective To investigate the effect of laparoscopic combined with esophageal cancer radical surgery and open surgery on perioperative outcome and postoperative quality of life.Methods The clinical data of 138 patients with esophageal cancer admitted to the hospital from January 2015 to October 2018 were retrospectively analyzed.They were divided into two groups according to different treatment methods,including 80 cases in the study group and 58 cases in the control group.The study group underwent thoracoscopic surgery combined with laparoscopic esophageal cancer,and the control group underwent thoracoscopic surgery plus open surgery.Perioperative effects,postoperative complications,and quality of life were compared between the two groups.Results The number of lymph node dissection in the control group was(14.08±5.79).Compared with the study group(13.90±4.62),the difference was not statistically significant(t=0.203,P=0.840).The blood loss and hospitalization time of the study group postoperative tube time and operation time were(185.34±179.59)mL,(12.19±4.88)d,(9.88±5.84)d,(351.42±63.78)min,and the control group was(288.18±120.01)mL,(15.82±4.21)d,(14.09±5.76)d,(313.17±56.42)min,the difference was statistically significant(t=4.259,4.465,4.204,3.648,P=0.000);the study group pneumonia,anastomotic leakage,gastric tract incidence of empty obstacles was 5.00%,6.25%,and 5.00%,which was lower than 29.31%,20.69%,and 24.14% of the control group.The difference was statistically significant(χ^2=15.402,6.491,10.858,P=0.000,0.011,0.001).There was no significant difference in the scores of social function between the two groups(P>0.05).The physical function,total health status and role score of the study group were higher than the control group.The fatigue,pain,cough difficulty and dyspnea score were lower than the control group.The difference was statistically significant(P<0.05).Conclusion The therapeutic effect of laparoscopic combined with esophageal cancer radical resection is equivalent to open surgery,and it has the advantages of small trauma,quick recovery and low complication rate,which can improve the quality of life of patients after operation.