食管癌三种不同手术方式围手术期指标及生存质量评分变化分析

Changes in perioperative indicators and quality of life scores associated with three different surgical options for esophageal cancer

目的:探讨食管癌微创及左、右进胸开胸根治术后围手术期相关指标及生存质量评分变化的情况。方法:回顾性分析2015年6月至2021年6月进行手术治疗的80例食管癌患者,其中31例采用左进胸食管癌根治术(左进胸组),22例患者采用右进胸食管癌根治术(右进胸组),27例患者采用微创食管癌根治术(微创组),比较三组患者围手术期各项指标及术后生存质量等的差异。结果:三组患者的临床资料进行比较,在性别、年龄、TNM分期及病理资料上无差异(P>0.05);在术中出血量无统计学差异(P>0.05),手术操作时间上,左进胸组明显少于右进胸和微创组(P<0.05),在淋巴结清扫个数、术后住院时间、胸腔引流管放置时间及胸腔引流量上差异有统计学意义(P<0.05);三组患者在术后CRP变化、术后疼痛视觉模拟评分(VAS)以及术后肺部感染、胸腔积液及心律失常等并发症的发生上,微创组均低于左进胸和右进胸组(P<0.05),而左进胸组与右进胸组无明显差异(P>0.05)。结论:三种手术方式治疗食管癌各有优缺点,左进胸组手术时间短、住院费用低,但清扫不彻底;右进胸组视野清晰,清扫彻底,但创伤大;微创组创伤小、术后疼痛轻、恢复快,使术后的炎症反应大大降低,提高了患者的生活质量,但该术式手术时间相对较长,费用较高,在基层医院推广受到一定的限制。因此,临床应根据患者的实际情况选取适当手术方式。

Objective:To investigate the changes in perioperative indicators and quality of life scores associated with minimally invasive,left⁃approach and right approach open esophagectomy for esophageal cancers.Methods:Retrospectively included were 80 esophageal cancer patients who underwent surgery between June 2015 and June 2021.Of them,31 patients underwent radical resection of esophagus cancer by left⁃approach open esophagectomy(LOE group),22 underwent right⁃approach open esophagectomy(ROE group),and 27 patients underwent minimally invasive esophagectomy(MIE group).The perioperative indicators and postoperative quality of life were compared among the three groups.Results:Comparison of the clinical data among the three groups of patients did not reveal differences in gender,age,TNM stage and pathological findings(P>0.05).While there was no statistical difference in blood loss at surgery(P>0.05),the operation was significantly shorter in the LOE group compared with the ROE and MIE groups(P<0.05).The number of lymph nodes dissected,postoperative length of hospital stay,indwelling days of chest drainage tube,and volume of chest drainage were statistically significant different among groups(P<0.05).After surgery,the C⁃reactive protein(CRP)level,visual analog scale(VAS)score of pain,incidence of complications including pulmonary infection,pleural effusion and arrhythmia were lower in patients of the MIE group,and were not significantly different between the LOE and ROE groups(P>0.05).Conclusion:Merits and demerits with these three surgical options for esophageal cancer are shown in our study.The left⁃approach open esophagectomy leads to shorter operation time and lower hospitalization expenses but less radical dissection of lymph nodes;the left⁃approach open esophagectomy allows for a clear surgical vision and radical dissection but is more traumatic;the minimally invasive surgery results in less trauma and postoperative pain,quicker recovery,remarkably milder postoperative inflammatory response and better quality of life in the patients,but is compromised by fairly longer operation time and higher medical expenses that hinders its widespread use in primary healthcare settings.Therefore,proper selection of the surgical option should be decided on a patient⁃specific basis.