胸腔镜辅助经右胸食管癌根治术治疗T1b期食管癌的效果

Effects of Thoracoscope Assisted Radical Resection via Right Chest in the Treatment of Stage T1b Esophageal Cancer

目的探讨胸腔镜辅助经右胸食管癌根治术对T1b期食管癌的治疗效果。方法回顾性分析165例T1b期食管癌患者的临床资料,其中72例接受开放食管癌根治术(对照组),93例接受胸腔镜辅助经右胸食管癌根治术(观察组),比较2组围术期指标、手术前后应激反应[C反应蛋白(CRP)、白细胞计数(WBC)、皮质醇(Cor)]、生活质量[癌症患者生活质量测定量表(EORTC QLQ-C30)]、生存情况、并发症发生率。结果观察组手术时间长于对照组(P<0.05),而术中输血量、输血率、术后疼痛视觉模拟评分、术后住院时间低/短于对照组(P<0.05),2组淋巴结清扫数目、带管时间、术后引流量比较差异无统计学意义(P>0.05)。观察组术后3 d CRP、WBC、Cor水平明显低于对照组(P<0.05)。观察组术后3个月、6个月EORTC QLQ-C30评分高于对照组(P<0.05)。2组1年、2年、3年生存率比较差异无显著性(P>0.05);观察组并发症发生率较对照组低(P<0.05)。结论与开放食管癌根治术相比,胸腔镜辅助经右胸食管癌根治术治疗T1b期食管癌疗效较好,可有效改善患者围术期指标,减轻应激反应,提高生活质量,降低并发症风险,且不影响远期生存,值得在临床推广实践。

Objective To investigate the effects of thoracoscope assisted radical resection via right chest in the treatment of stage T1b esophageal cancer.Methods The clinical data of 165 patients with stage T1b esophageal cancer were retrospectively analyzed.72 patients treated with open radical resection of esophageal cancer were included in the control group,and 93 patients treated with thoracoscope assisted radical resection of esophageal cancer were included in the observation group.Perioperative indicators,stress response[C-reactive protein(CRP),white blood cell count(WBC),cortisol(Cor)]before and after surgery,quality of life[European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30(EORTC QLQ-C30)],survival and incidence of complications were compared between the 2 groups.Results The operation time of the observation group was longer than that of the control group(P<0.05),while the intraoperative blood transfusion volume,blood transfusion rate,pain visual analogue score and postoperative hospital stay were smaller/lower/shorter than those of the control group(P<0.05).There was no significant difference in the number of lymph nodes removed,time of bearing tube or postoperative drainage volume between the 2 groups(P>0.05).The levels of CRP,WBC and Cor in observation group at 3 days after operation were significantly lower than those of the control group(P<0.05).EORTC QLQ-C30 scores of the observation group were higher than those of the control group at 3 and 6 months after operation(P<0.05).There was no significant difference in the 1-year,2-year or 3-year survival rate between the 2 groups(P>0.05).The incidence of complications in the observation group was lower than that of the control group(P<0.05).Conclusion Compared with open radical resection of esophageal cancer,thoracoscope assisted radical resection of esophageal cancer via right chest is more effective in treating stage T1b esophageal cancer.The latter can effectively improve perioperative indexes,relieve stress response,improve quality of life and reduce risk of complications,without affecting long-term survival.