摘要
目的探讨食管癌微创切除术（minimally invasive esophagectomy,MIE）的安全性及临床价值。方法回顾性分析2011年5月~2014年5月112例Ⅱ、Ⅲ期食管癌行食管癌根治术的临床资料。根据手术方式的不同,53例接受胸、腹腔镜联合食管癌切除术为微创组,59例接受传统开放食管癌切除术为开放组。结果微创组淋巴结清扫数目（26.3±7.7）枚,显著多于开放组（20.6±8.2）枚（t=3.788,P=0.000）;术后并发症发生率22.6%（12/53）,明显低于开放组62.7%（37/59）（χ~2=18.216,P=0.000）。微创组心律失常发生率3.8%（2/53）,显著低于开放组15.2%（9/59）（χ~2=4.155,P=0.042）;肺部感染发生率1.9%（1/53）,显著低于开放组15.2%（9/59）（χ~2=4.602,P=0.032）;喉返神经损伤发生率3.8%（2/53）,显著低于开放组18.6%（11/59）（χ~2=6.018,P=0.014）。微创组胃排空障碍发生率1.9%（1/53）,与开放组3.4%（2/59）无统计学差异（χ~2=0.000,P=1.000）;乳糜胸发生率3.8%（2/53）,与开放组1.7%（1/59）无统计学差异（χ~2=0.009,P=0.925）;吻合口漏发生率3.8%（2/53）,与开放组3.4%（2/59）无统计学差异（χ~2=0.000,P=1.000）;吻合口狭窄发生率3.8%（2/53）,与开放组5.1%（3/59）无统计学差异（χ~2=0.000,P=1.000）。结论 MIS可以更好地进行淋巴结清扫,心律失常、肺部感染和喉返神经损伤发生率明显低于开放手术。
Objective To explore the safety and clinical value of minimally invasive esophagectomy. Methods A retrospective analysis of clinical data of 112 cases of stage Ⅱ or Ⅲ esophageal cancer from May 2011 to May 2014 was carried out.According to the different ways of operation,53 patients who underwent resection of thoracic esophageal carcinoma combined with laparoscopy were classified as minimally invasive group,and the other 59 patients receiving traditional open resection of esophageal carcinoma were studied as the open group. Results The number of lymph node dissection in the minimally invasive group（ 26. 3 ±7. 7） was significantly more than that in the open group（ 20. 6 ± 8. 2）（ t = 3. 788,P = 0. 000）. The incidence of postoperative complications was significantly lower in the minimally invasive group（ 22. 6%,12 /53） than that in the open group [62. 7%（ 37 /59）,χ~2= 18. 216,P = 0. 000]. In the minimally invasive group,the incidence of arrhythmia,pulmonary infection and recurrent laryngeal nerve injury were significantly lower than those in the open group [3. 8%（ 2 /53） vs. 15. 2%（ 9 /59）,χ~2= 4. 155,P =0. 042; 1. 9%（ 1 /53） vs. 15. 2%（ 9 /59）,χ~2= 4. 602,P = 0. 032; 3. 8%（ 2 /53） vs. 18. 6%（ 11 /59）,χ~2= 6. 018,P = 0. 014].There were no significant differences between the minimally invasive group and the open group in gastric emptying [1. 9%（ 1 /53） vs.3. 4%（ 2 /59）,χ~2= 0. 000,P = 1. 000],postoperative chylothorax [3. 8%（ 2 /53） vs. 1. 7%（ 1 /59）,χ~2= 0. 009,P = 0. 925],anastomotic fistula [3. 8%（ 2 /53） vs. 3. 4%（ 2 /59）,χ~2= 0. 000,P = 1. 000] and anastomotic stricture rate [3. 8%（ 2 /53） vs.5. 1%（ 3 /59）,χ~2= 0. 000,P = 1. 000]. Conclusion Minimally invasive resection of esophageal carcinoma can obtain better lymph node dissection outcomes than open operation,with lower incidences of arrhythmia,pulmonary infection,and recurrent laryngeal nerve injury.
出处
《中国微创外科杂志》
CSCD
北大核心
2016年第3期205-208,共4页
Chinese Journal of Minimally Invasive Surgery
关键词
食管癌
微创食管癌切除术
淋巴结清扫
Esophageal cancer
Minimally invasive esophagectomy
Lymph node dissection
