胸腹腔镜联合下食管癌切除术与开放手术的临床疗效对比

Comparison of clinical efficacy between thoracoscopic laparoscopy combined with esophagectomy and open surgery

目的对比胸腹腔镜联合下食管癌切除术与开放手术治疗胸段食管癌的临床疗效。方法选取合肥市第三人民医院和安徽省立医院2015年1月-2020年12月收治的207例胸段食管癌患者作为研究对象,依据手术方案分为胸腹腔镜组(n=81)和开放组(n=126)。胸腹腔镜组采用胸腹腔镜联合下食管癌切除术治疗,开放组采用开放手术治疗,比较两组患者围手术期指标、手术并发症和近期生存情况。结果两组患者均顺利完成手术,无手术死亡病例,两组患者手术时间比较,差异无统计学意义(P>0.05)。胸腹腔镜组较开放组术中出血量少[(141.48±82.03)和(217.85±12.51)mL],差异有统计学意义(P<0.05);两组患者术后住院时间[(16.00±5.39)和(18.88±8.79)d]以及淋巴结清扫数[(29.70±11.63)和(33.67±17.87)枚]比较,差异均无统计学意义(P>0.05);胸腹腔镜组喉返神经旁淋巴结清扫数较开放组多(7.41和4.86枚/例),差异有统计学意义(P<0.05);两组患者肺部并发症、心脏并发症和吻合口瘘发生率比较,差异均无统计学意义(P>0.05),但胸腹腔镜组喉返神经损伤率较开放组高(29.6%和11.9%),差异有统计学意义(P<0.05);两组患者1年生存率(100.0%和90.5%)比较,差异无统计学意义(P>0.05)。结论胸腹腔镜联合下食管癌切除术治疗胸段食管癌安全可行,可减少手术出血量,在上纵隔尤其是喉返神经旁淋巴结清扫上优势明显,值得临床推广使用。

Objective To compare the clinical efficacy of thoracoscopic laparoscopy combined with esophagectomy and open surgery in treatment of thoracic esophageal cancer.Methods 207 patients with thoracic esophageal cancer treated in the Third People's Hospital of Hefei and Anhui Provincial Hospital from January 2015 to December 2020 were selected as the research objects and divided into thoracoscopic laparoscopy group(n=81)and open group(n=126).The thoracoscopic laparoscopy group was treated with thoracoscopic laparoscopy combined with esophagectomy,and the open group was treated with open surgery.The perioperative indicators,surgical complications and short-term survival were compared between the two groups.Results The operation was successfully completed in the two groups,and there was no operative death.There was no significant difference in the operation time between the two groups(P>0.05).The intraoperative blood loss in the thoracoscopic laparoscopy group was less than that in the open group[(141.48±82.03)and(217.85±12.51)mL],and the difference was statistically significant(P<0.05);postoperative hospital stay[(16.00±5.39)and(18.88±8.79)d],the number of lymph nodes dissected[(29.70±11.63)and(33.67±17.87)],the difference was not statistically significant(P>0.05);the number of dissected lymph nodes next to the recurrent laryngeal nerve in the thoracoscopic laparoscopy group was more than that in the open gruop(7.41 and 4.86 pieces/case),and the difference was statistically significant(P<0.05).There was no significant difference in the incidence of pulmonary complications,cardiac complications and anastomotic leakage between the two groups(P>0.05),but the rate of recurrent laryngeal nerve injury in the thoracoscopic laparoscopy group was higher than that in the open group(29.6%and 11.9%),and the difference was statistically significant(P<0.05).There was no significant difference in the 1-year survival rate between the two groups(100.0%and 90.5%)(P>0.05).Conclusion Thoracoscopic laparoscopy combined with esophagectomy for thoracic esophageal cancer is safe and feasible.It has obvious advantages in reducing the amount of surgical blood loss and strengthening the dissection of the upper mediastinum,especially the lymph nodes next to the recurrent laryngeal nerve,and has important promotion and application value.