胸腔镜联合腹腔镜辅助下Ⅱ、Ⅲ期食管癌切除二野淋巴结清扫临床研究

Clinical Study on Lymph Node Dissection in Two Fields of StageⅡandⅢEsophageal Carcinoma Resection with the Assistance of Thoracoscopy and Laparoscopy

目的以Ⅱ、Ⅲ期食管癌患者为研究对象,对其采取胸腹腔镜辅助下根治手术+二野淋巴结清扫治疗,分析其临床疗效。方法方便选取2016年6月—2019年6月在该院治疗的220例食管癌患者,将其分为两组。对照组110例(三切口食管癌切除术+淋巴结清扫治疗);观察组110例(胸腹腔镜辅助下根治手术+二野淋巴结清扫治疗),对比手术指标、炎症细胞因子、并发症情况。结果观察组患者的手术时间、住院时间、术中出血量(277.78±16.26)min、(13.23±2.50)d、(270.46±14.89)mL明显短于对照组,观察组术后IL-6、IL-10、TNF-α水平(2.03±0.55)pg/mL、(0.53±0.26)pg/mL、(1.62±0.43)ng/mL均明显低于对照组,差异有统计学意义(t=7.323、10.857、62.230、11.807、8.006、16.667,P<0.05);观察组患者的肺部感染、声音嘶哑、心律失常发生率(10.91%、7.27%、1.82%)均明显低于对照组(26.36%、20.00%、10.91%),差异有统计学意义(χ^(2)=8.663、7.565、5.232,P<0.05)。结论胸腹腔镜辅助下根治手术+二野淋巴结清扫可达到与传统手术相当的淋巴清扫效果,同时可降低手术创伤及术后炎症反应,减少并发症发生。

Objective To take the patients with stageⅡandⅢesophageal cancer as the research object,to take thoracoscopic-assisted radical surgery+second-field lymph node dissection treatment to analyze the clinical efficacy.Methods A total of 220 esophageal cancer patients treated in this hospital from June 2016 to June 2019 were selected and divided into two groups.110 cases in the control group(three-incision esophageal cancer resection+lymph node dissection treatment);110 cases in the observation group(thoracoscopic assisted radical surgery+two-field lymph node dissection treatment).The surgical indicators,inflammatory cytokines,and complications were compared.Results The operation time,hospitalization time,and intraoperative blood loss of the observation group were(277.78±16.26)min,(13.23±2.50)d,and(270.46±14.89)mL were significantly shorter than those of the control group.After operation,the observation group's IL-6,IL-10,TNF-α(2.03±0.55)pg/mL,(0.53±0.26)pg/mL,and(1.62±0.43)ng/mL were significantly lower than those of the control group,and the difference was statistically significant(t=7.323,10.857,62.230,11.807,8.006,16.667,P<0.05);the incidence of lung infection,hoarseness,and arrhythmia(10.91%,7.27%,1.82%)of the observation group were significantly lower than those of the control group(26.36%,20.00%,10.91%),the difference was statistically significant(χ^(2)=8.663,7.565,5.232,P<0.05).Conclusion Thoracic laparoscopic-assisted radical surgery+second-field lymph node dissection can achieve a lymphatic dissection effect equivalent to that of traditional surgery.At the same time,it can reduce surgical trauma and postoperative inflammation,and reduce complications.