胸腔镜联合腹腔镜食管癌手术的临床应用研究

Clinical application of thoracoscopic and laparoscopic surgery for esophageal carcinoma

目的探讨胸腔镜联合腹腔镜手术治疗食管癌的可行性、安全性及临床效果。方法回顾性分析2015年9月—2017年10月本院收治的胸腔镜联合腹腔镜食管癌根治术(即微创组95例)和常规三切口开放食管癌根治术(即开放组74例)食管癌患者临床资料。比较两组手术指标及近期临床疗效。结果两组总手术时间、术后ICU监护时间、平均淋巴结清扫数比较,无统计学差异(P>0.05),但微创组术中出血量明显少于开放组[(501±39) ml比(1002±51) ml],组间差异有统计学意义(P<0.05)。术后第1、3、4天血C反应蛋白值低于开放组,组间差异有统计学意义P<0.05。术后微创组呼吸系统并发症发生率低(9.4%比24.3%),颈部吻合口瘘发生率亦降低(6.3%比16.2%),差异均有统计学意义(P>0.05)。微创组和开放组患者术后总住院时间分别为(10.9±1.8)天和(16.2±3.0)天,差异有统计学意义。结论胸腔镜联合腹腔镜手术治疗食管癌创伤小,并发症少,术后恢复快,近期疗效可靠,安全可行。

Objective To explore the feasibility,safety and clinical effect of thoracoscopic and laparoscopic surgery treatment for esophageal carcinoma. Methods Retrospectively analyzed the clinical data of the 169 patients with esophageal cancer those who admitted to the hospital during September 2015 and October2017. 95 patients received minimally invasive esophagectomy( MIE group), while 74 patients underwent conventional open esophagectomy( OE group: viarigl’t thorax,abdomen,left neck).The operative procedures,short term outcome were collected and compared between the two groups. Results No significant differences were found in total operation time,the number of lymph nodes dissection and ICU stay between the two groups. Median blood loss in MIE group was less than that in OE group( 501±39 ml vs.1002±51 ml,P<0.05). Serum CRP levels were significantly reduced in the MIE group compared to those in the open group on postoperative days 1,3,and4. The incidence of pulmonary complications was significantly reduced in the MIE group compared with the open group( 9.4%vs.24.3%,P<0.05). The anastomotic leakages was significantly reduced in the MIE group compared with the open group( 6.3%vs.16.2%,P<0.05). The hospital stay duration was significantly shorter( P<0.035) in the MIE group( 10. 9 ± 1. 8 days) than in the open group( 16. 2 ± 3. 0 days). Conclusions Combination of thoracoscope and laparoscope for the treatment of esophageal carcinoma is feasible and safe with small trauma,fewer complications,rapid postoperative recover and reliable short-term effect.