胸腹腔镜联合手术与开放手术治疗不同病理分期食管癌的短期疗效比较

Thoracolaparoscopic esophagectomy and open surgery for different pathological stages of esophageal cancer:a comparison of short-term efficacy

目的探讨胸腹腔镜联合微创手术与传统开放手术对不同病理分期食管癌短期预后的影响,为不同病理分期食管癌的手术选择提供依据。方法回顾性分析我科2017年1月至2018年12月间收治并行食管癌根治术的280例患者的临床资料,依据手术方式分为微创组和开放组。比较两组的围术期预后、术后并发症及不同病理分期行两种手术方式的短期疗效。结果微创组81例,开放组199例。术后病理诊断为0期8例,Ⅰ期43例,Ⅱ期103例,Ⅲ期106例,Ⅳa期20例。与开放组相比,微创组手术时间明显长于开放组(P<0.05),术中出血量明显少于开放组(P<0.05);两组病例术后住院时间无统计学差异(P>0.05),但微创组术后恢复饮食所需时间更长(P<0.05)。两组病例总的术后并发症发生率无明显差异(P>0.05),但微创组更容易发生吻合口瘘(P<0.05),开放组更容易出现肺部感染及胸腔积液(P<0.05)。在不同病理分期食管癌患者中,微创组的手术时间普遍更长(F=20.231,P<0.05),而病理分期对于手术时间无明显影响(F=1.300,P>0.05)。病理分期与手术方式对于患者术后恢复饮食时间、术后住院时间有共同作用(交互作用的主效应,P<0.05)。相较于其它分期患者,0期和Ⅳ期患者术后恢复饮食时间、术后住院时间均更短(P<0.05)。对于Ⅳ期,无法行根治性切除、仅行R0期切除患者,微创组更能有效缩短术后恢复饮食时间及术后住院时间(P<0.05)。结论胸腹腔镜联合微创食管癌根治术在减少术中出血、降低肺部并发症发生率等方面具有明显优势。对于非R0切除的患者,微创手术更利于患者术后快速恢复,从而得以尽快进行术后继续治疗,对延长晚期患者的生活质量、生存期限具有重要意义。

Objective To investigate the effect of minimally invasive thoracolaparoscopic or open esophagectomy on the short-term prognosis of esophageal cancer with different pathological stages and provide clinical experience for surgical selection for the patients.Methods A retrospective analysis was performed on the clinical data of 280 patients undergoing radical resection due to esophageal cancer in our department from January 2017 to December 2018.According to the surgical approaches,they were divided into minimal invasive group(MI,n=81)and open surgery group(OS,n=199).The perioperative prognosis,postoperative complications,and short-term efficacy of 2 surgical methods for different pathological stages were compared between the 2 groups.Results For the totally 280 patients,postoperative pathological diagnosis identified 8 cases of stage 0,43 cases of stage I,103 cases of stage II,106 cases of stageⅢand 20 cases of stageⅣ.The MI group had a significantly longer operation time and less intraoperative blood loss when compared with the OS group(both P<0.05).Though there was no statistical difference in postoperative hospital stay between the 2 groups(P>0.05),the time needed for postoperative diet recovery was obviously longer in the MI group(P<0.05).The total incidences of postoperative complications were similar(P>0.05),but the patients of the MI group were prone to anastomotic fistula(P<0.05),while those of the other group to pulmonary infection and pleural effusion(P<0.05).Among the patients with different pathological stages of esophageal cancer,the operation time in the MI group was generally longer than that in the OS group(F=20.231,P<0.05),while the pathological stage did not affected the operation time(F=1.300,P>0.05).The pathological stage and surgical approach had a joint effect on the postoperative diet recovery time and hospital stay time(main effect of interaction,P<0.05).The patients with 0 orⅣstage had a shorter recovery time than those with other stages(P<0.05).For theⅣstage patients who could not undergo radical resection but only underwent R0 resection,the minimally invasive surgery was more effective in shortening the postoperative diet recovery time and hospital stay time(P<0.05).Conclusion Compared with OS,thoracolaparoscopic surgery has obvious advantages in reducing intraoperative bleeding and incidence of pulmonary complications.For the patients who cannot undergo radical(R0)resection,minimally invasive surgery can accelerate postoperative recovery,which is of great significance in performing continuous treatment as soon as possible,promoting the quality of life and prolonging the survival period of the patients.