胸腹腔镜手术治疗食管癌的安全性及效果

Efficacy and Safety of Laparoscopic Surgery for Thoracic Esophageal Cancer

目的探讨胸腹腔镜手术治疗食管癌的安全性及效果。方法将80例食管癌患者按照选择手术方式不同分为胸腹腔镜组(48例)和开胸手术组(32例)。胸腹腔镜组给予胸腹腔镜联合手术,并且行周围淋巴结清扫手术;开胸手术组直接给予开胸癌症切除和周围淋巴结清扫手术。观察2组治疗效果和不良事件发生情况。结果 2组患者均成功完成手术,无死亡病例。胸腹腔镜组的手术时间、淋巴结清扫数均高于开胸手术组,但差异无统计学意义(P>0.05);术中出血量、术后住院时间、胸液引流量均低于开胸手术组,差异具有统计学意义(P<0.05);手术费用高于开胸手术组,差异具有统计学意义(P<0.05)。术后随访1年,2组1年生存率均为100.00%,差异无统计学意义(P>0.05)。2组发生不良事件主要有脏器损伤、感染、喉返神经损伤、吻合口瘘、心率失常、胃排空障碍、乳糜胸。胸腹腔镜组不良事件发生率为6.25%,开胸手术组为43.75%,差异具有统计学意义(P<0.05)。结论胸腹腔镜手术出血量少、术后住院时间短、胸液引流量多,并且术中创伤小,术中不良事件发生率低,具有一定安全性。

Objective To investigate the efficacy and safety of laparoscopic surgery for thoracic esophageal cancer.Methods 80 cases of esophageal cancer,according to the choice of surgical approach,were divided into thoracic laparoscopic group( 48 cases) and thoracotomy group( 32 cases),and thoracic laparoscopic group received thoracic laparoscopic surgery and lymph node dissection,thoracotomy group was given thoracotomy cancer resection and lymph node dissection,treatment effects and adverse events of the 2 groups were observed. Results All patients successfully completed surgery with no deaths,the patients were followed up for 1 year,1-year survival rates of the 2 groups both were 100. 00%,the difference was not statistically significant( P > 0. 05); surgery time and the number of lymph node dissection in thoracic laparoscopic group were higher than those of the thoracotomy group,but the difference was not statistically significant( P > 0. 05),blood loss,postoperative hospital stay,pleural fluid drainage volume in thoracic laparoscopic group were lower than those of the thoracotomy group,the difference was statistically significant( P < 0. 05),cost of surgery in thoracic laparoscopic group was higher than that of thoracotomy group,the difference was statistically significant( P < 0. 05). The adverse events were mainly organ damage,infection,recurrent laryngeal nerve injury,anastomotic leak,heart disorders,delayed gastric emptying,chylothorax. Adverse reaction rate in thoracic laparoscopic group was 6. 25%,and in thoracotomy group was 43. 75%,the difference was statistically significant( P < 0. 05). Conclusion Thoracic laparoscopy surgery have less bleeding,shorter hospital stay,more pleural fluid drainage,less invasive trauma,and low intraoperative adverse events,it has certain security.