胸腹腔镜联合食管癌根治术治疗食管癌患者的疗效及安全性探讨

Efficacy and Safety of Thoracic Laparoscopy Combined with Radical Re⁃section of Esophageal Cancer in Patients with Esophageal Cancer

目的探讨胸腹腔镜联合食管癌根治术治疗食管癌患者的疗效及安全性。方法回顾性分析东台市人民医院心胸外科2018年1月—2021年6月期间收治的60例食管癌患者的临床资料。按不同手术方法分为两组,32例实施胸腹腔镜联合食管癌根治术患者为观察组,28例实施开放性食管癌根治术患者作为对照组;比较两组手术参数指标、并发症、创伤应激反应等。结果观察组手术时间(263.58±42.76)min,长于对照组(219.36±38.61)min,切口长度(7.53±1.26)cm、出血量(218.53±36.56)mL、胃肠功能恢复时间(1.63±0.43)d、引流时间(4.28±0.73)d、卧床时间(5.43±1.18)d、住院时间(5.43±1.18)d,均低于对照组切口长度(32.68±3.74)cm、出血量(448.81±41.73)mL、胃肠功能恢复时间(4.18±0.71)d、引流时间(6.51±1.03)d、卧床时间(8.08±1.24)d、住院时间(17.93±2.80)d,差异有统计学意义(t=35.824,22.787,17.064,9.766,8.475,3.679,P<0.05),两组淋巴结清扫数目比较,差异无统计学意义(P>0.05)。观察组术后1 d创伤应激指标、炎症反应以及并发症占比率均低于对照组,差异有统计学意义(P<0.05),两组术后1年肿瘤转移、复发及生存率比较,差异无统计学意义(P>0.05)。结论胸腹腔镜联合食管癌根治术治疗食管癌患者的近期效果与开放性手术相当,且能减少并发症发生,创伤应激反应低,值得临床进一步论证。

Objective To investigate the efficacy and safety of thoracic laparoscopy combined with radical resection of esophageal cancer in the treatment of patients with esophageal cancer.Methods The clinical data of 60 patients with esophageal cancer admitted to the Department of Cardiothoracic Surgery of Dongtai People's Hospital from January 2018 to June 2021 were retrospectively analyzed.They were divided into two groups according to different surgical methods,32 patients who underwent thoracic laparoscopy combined with radical esophagectomy for esophageal cancer were the observation group,and 28 patients who underwent open radical esophagectomy for esophageal cancer were the control group.The surgical parameters,complications and traumatic stress response were compared between the two groups.Results In the observation group,the operation time was(263.58±42.76)min,longer than in the control group(219.36±38.61)min,the incision length was(7.53±1.26)cm,the amount of bleeding was(218.53±36.56)mL,the recovery time of gastrointestinal function was(1.63±0.43)d,and the drainage time was(4.28±0.73)d,the length of bed was(5.43±1.18)d and the length of hospital stay was(5.43±1.18)d;incision length(32.68±3.74)cm,bleeding amount(448.81±41.73)mL,gastrointestinal function recovery time(4.18±0.71)d,drainage time(6.51±1.03)d,bed time(8.08±1.24)were all lower than those of control group.The difference was statistically significant(t=35.824,22.787,17.064,9.766,8.475,3.679,all P<0.05).The number of lymph node dissection between the two groups was compared,the difference was not statistically significant(P>0.05).The traumatic stress index,inflammatory reaction and complication ratio in the observation group were lower than those in the control group 1 day after surgery,the dif⁃ference was statistically significant(P<0.05).Comparison of tumor metastasis,recurrence and survival rate 1 year after surgery between the two groups,the difference was not statistically significant(P>0.05).Conclusion The short-term ef⁃fect of thoracic laparoscopy combined with radical resection of esophageal cancer in the treatment of patients with esophageal cancer is similar to that of open surgery,and can reduce complications and reduce traumatic stress re⁃sponse,which is worthy of further clinical demonstration.