管状胃经胸骨后路径与经食管床路径应用于胸腔镜联合食管癌手术对治疗成功率肺功能及术后并发症的影响

Effect of Tube Stomach Retrosternal and Transesophageal Bed Pathways on the Success Rate Lung Function and Postoperative Complications of Thoracoscopic Combined with Esophageal Cancer Surgery

目的:探索管状胃经胸骨后路径与经食管床路径应用于胸腔镜联合食管癌手术对治疗成功率、肺功能及术后并发症的影响。方法:选取2019年1月至2020年6月本院收治的胸腔镜联合食管癌手术60例,按照简单随机数字表法分为食管床路径组、胸骨后路径组各30例。观察两组患者治疗成功率、手术期间指标、术后24h肺功能指标、术后并发症、术后7d后生活质量差异。结果:两组患者均顺利完成手术,成功率100%,围术期间未出现死亡状况,无统计学差异(P>0.05)。两组患者手术用时、术中出血量、住院时长、引流管留置时间无统计学差异(P>0.05),食管床路径组患者胃肠减压液显著高于胸骨后路径组,具有统计学差异(P<0.05)。两组患者治疗后FVC、呼吸频率较治疗前有显著改善(P<0.05),但组间无明显差异(P>0.05),两组在吻合口狭窄、肺部感染、心律失常、并发症合计比较无明显差异(P>0.05),但胸骨后路径组吻合口瘘发生情况显著高于食管床路径组(P<0.05),广义估计方程分析结果显示:组间方面,重复测量结果显示,Waldχ2=5.317,P=0.021,组间差异具有统计学意义(P<0.05),OR=e1.159=3.150,95%置信区间为(e0.174,e2.144)=(0.473,5.828),提示食管床路径组患者术后反酸烧心发作率显著高于对照组;时点方面,Waldχ2=23.304,P=0.000,时间差异具有统计意义(P<0.05),提示不同时点下患者发作率差异显著。两组患者术后质量分值较术前有显著改善(P<0.05),但组间无明显差异(P>0.05)。结论:管状胃经胸骨后路径与经食管床路径应用于胸腔镜联合食管癌手术中,两者均有良好效果,治疗成功率高、安全性强、有助于改善患者术后肺功能与生活质量,前者胃肠减压液相对较少,吻合口瘘发生概率较大,后者肠胃反流较严重,临床可根据具体情况选择合适方式进行个体化治疗。

Objective:To explore the effect of the trans-sternal route of tubular stomach and trans-esophageal bed route on the success rate,lung function and postoperative complications of thoracoscopic esophageal cancer surgery.Methods:From January 2019 to June 2020,60 cases of thoracoscopic combined with esophageal cancer surgery in our hospital were selected and divided into esophageal bed pathway group and retrosternal pathway group according to the simple random number table method,with 30 cases in each group.The treatment success rate,indexes during operation,indexes of pulmonary function 24 hours after operation,postoperative complications and quality of life 7 days after operation were observed.Results:The patients of two groups were successfully completed the operation,the success rate was 100%.There was no death during the perioperative period.There was no statistical difference(P>0.05).There was no significant difference in operation time,intraoperative blood loss,length of hospital stay and indwelling time of drainage tube between the two groups(P>0.05).The gastrointestinal decompression fluid in the esophageal bed pathway group was significantly higher than that in the retrosternal pathway group(P<0.05).FVC and respiratory rate of the two groups were significantly improved after treatment(P<0.05),but there was no significant difference between the two groups(P>0.05).There was no significant difference in anastomotic stenosis,pulmonary infection,arrhythmia and complications between the two groups(P>0.05),but the incidence of anastomotic leakage in the retrosternal pathway group was significantly higher than that in the esophageal bed pathway group(P<0.05).The difference between the two groups was statistically significant(P<0.05),or=e1.159=3.150,95%confidence interval was(e0.174,e2.144)=(0.473,5.828),suggesting that the incidence of acid reflux heartburn in the esophageal bed pathway group was significantly higher than that in the control group.The time difference was statistically significant(P<0.05),suggesting that the attack rate of patients at different time points had significant difference.The postoperative quality scores of the two groups were significantly improved(P<0.05),but there was no significant difference between the two groups(P>0.05).Conclusion:The results show that the tube stomach retrosternal path and transesophageal bed path had good effect in thoracoscopic combined with esophageal cancer surgery,with high success rate,strong safety,and help to improve the postoperative lung function and quality of life of patients.The former had relatively less gastrointestinal decompression fluid,higher probability of anastomotic leakage,and the latter had more serious gastrointestinal reflux,so it can be selected according to the specific situation Methods individualized treatment.