胸腹腔镜食管癌根治术联合胸内吻合术治疗食管癌的临床效果探讨

Discussion on clinical effect of thoraco-laparoscopic esophagectomy combined with intrathoracic anastomosis in the treatment of esophageal cancer

目的探究胸腹腔镜食管癌根治术联合胸内吻合术治疗食管癌患者的疗效及对手术指标和并发症的影响,分析其临床应用价值。方法78例食管癌患者,根据手术方式的不同分为对照组和实验组,各39例。对照组患者实施开胸食管癌根治术联合胸内吻合术,实验组患者实施胸腹腔镜食管癌根治术联合胸内吻合术。比较两组患者手术指标、并发症发生情况及肺功能指标[第1秒用力呼气容积(FEV1)、第1秒用力呼气容积占预计值的百分比(FEV1%)及第1秒用力呼气容积与用力肺活量的比值(FEV1/FVC)]。结果实验组患者手术操作时间(213.48±23.15)min短于对照组的(265.95±15.63)min,淋巴结清扫数量(16.29±2.12)枚多于对照组的(11.21±3.21)枚,手术出血量(175.63±17.26)ml少于对照组的(216.28±20.26)ml,差异有统计学意义(P<0.05)。实验组患者并发症发生率5.13%明显低于对照组的20.51%,差异有统计学意义(P<0.05)。术前,两组患者FEV1、FEV1%及FEV1/FVC比较,差异无统计学意义(P>0.05);术后,两组患者FEV1、FEV1%及FEV1/FVC高于术前,且实验组患者FEV1(2.76±0.31)L、FEV1%(86.28±4.26)%及FEV1/FVC(66.68±4.59)%高于对照组的(1.94±0.35)L、(79.65±4.23)%、(59.69±4.26)%,差异有统计学意义(P<0.05)。结论胸腹腔镜食管癌根治术与胸内吻合术联合应用于食管癌患者的临床治疗中,疗效确切,能够在应用过程中有效改善患者的各项基本手术指标,同时还能够降低并发症发生率,具有良好的临床应用价值。

Objective To investigate the efficacy of thoraco-laparoscopic esophagectomy combined with intrathoracic anastomosis in the treatment of patients with esophageal cancer and its influence on surgical indexes and complications,and analyze its clinical application value.Methods A total of 78 patients with esophageal cancer were divided into a control group and an experimental group according to different surgical methods,with 39 cases in each group.The control group underwent open esophagectomy combined with intrathoracic anastomosis,while the experimental group underwent thoraco-laparoscopic esophagectomy combined with intrathoracic anastomosis.Both groups were compared in terms of surgical indicators,complications and pulmonary function indicators[forced expiratory volume in one second(FEV1),FEV1 as a percentage of the expected value(FEV1%)and the ratio of FEV1 to forced vital capacity(FEV1/FVC)].Results The operative time of(213.48±23.15)min in the experimental group was shorter than that of(265.95±15.63)min in the control group;the number of lymph nodes dissection of(16.29±2.12)nodes in the experimental group was higher than that of(11.21±3.21)nodes in the control group;the amount of blood loss of(175.63±17.26)ml in the experimental group was less than that of(216.28±20.26)ml in the control group;the differences were statistically significant(P<0.05).The complication rate of 5.13%in the experimental group was significantly lower than that of 20.51%in the control group,and the difference was statistically significant(P<0.05).Before surgery,there was no statistically significant difference in FEV1,FEV1%and FEV1/FVC between the two groups(P>0.05).After surgery,FEV1,FEV1%and FEV1/FVC in both groups were higher than those before surgery in this group;the experimental group had FEV1 of(2.76±0.31)L,FEV1 of(86.28±4.26)%and FEV1/FVC of(66.68±4.59)%,which were higher than those of(1.94±0.35)L,(79.65±4.23)%and(59.69±4.26)%in the control group;the differences were statistically significant(P<0.05).Conclusion The combination of thoraco-laparoscopy and intrathoracic anastomosis in the clinical treatment of patients with esophageal cancer has a definite effect,which can effectively improve the basic surgical indicators of patients in the process of application,and can also reduce the incidence of complications of patients,with good clinical application value.