全胸腔镜和混合胸腔镜手术在食管癌外科治疗中的应用比较

Comparison of complete and hybrid thoracoscopic approaches in the surgical treatment of esophageal cancer

目的:比较混合胸腔镜和全胸腔镜手术在食管癌外科治疗中的安全性、可行性及手术切除效果。方法:回顾性分析2018年1月至2020年1月经右胸食管癌根治术患者的临床病例资料,比较混合胸腔镜手术(混合腔镜组)和全胸腔镜手术(全腔镜组)术前、术中和术后等方面的差异。结果:全腔镜组较混合腔镜组在手术时间有所延长[(455±79) min vs (439±76) min,P=0.035)],混合腔镜组在术中出血、术后胸管引流时间、腹腔引流时间、ICU住院及术后住院时间较全腔镜组有所延长;全腔镜组清扫淋巴结站数及枚数多于混合腔镜组[(7.8±2.4) vs (7.3±2.1),P=0.022;(19.6±4.3) vs (18.5±3.2),P=0.003)];全腔镜组术后总体并发症低于混合腔镜组(7.4%vs13.6%,P=0.049)。结论:全腔镜食管癌根治术具有出血少、术后恢复快、术后并发症少,对肺功能影响较小、术后生活质量高等优点,全腔镜食管癌根治术可获得良好的疗效。

Objective:To compare the feasibility,safety,and efficacy of hybrid and complete thoraco⁃scopic surgery in the treatment of esophageal carcinoma.Methods:A retrospective analysis was made from January 2018 to January 2020 on the clinical data of patients who received right thoracic esophageal cancer resection,and the patients were divided into hybrid or complete laparoscopic groups.Results:The operation time of the complete laparoscopic group was longer than that of the hy⁃brid laparoscopic group,as(455±79)min vs(439±76)min,P=0.035.More intraoperative bleeding,longer chest drainage time,peritoneal drainage time,ICU hospitalization,and postopera⁃tive hospitalization time were found in the hybrid laparoscopic group as compared with those in the complete laparoscopic group.As for histopathology,lymph node dissection stations and the lymph node numbers in the complete laparoscopic group were more than those in the hybrid laparoscopic group as(7.8±2.4)vs(7.3±2.1),P=0.022,and(19.6±4.3)vs(18.5±3.2),P=0.003,respec⁃tively.The postoperative complication rate in the complete laparoscopic group was less than that in the hybrid laparoscopic group(7.4%vs 13.6%,P=0.049).Conclusion:Total endoscopic radical resection of esophageal cancer has the advantages of less bleeding,quick postoperative recovery,few⁃er postoperative complications,less impact on lung function,and higher postoperative quality of life.