摘要
背景与目的：传统三切口手术是治疗食管癌的重要手段，但术后并发症多、死亡率高。微创食管切除术是目前胸外科发展的方向，具有创伤小、恢复快等特点。该研究回顾性分析2013年1月-2015年1月在新疆医科大学附属肿瘤医院接受胸腹腔镜（thoracoscopic-laparoscopic esophagectomy, TLE）、单纯腹腔镜（open-laparoscopic esophagectomy, OLE）以及开放手术（open esophagectomy，OE）的食管癌患者的临床资料，比较3组围手术期手术疗效。方法：TLE组72例，OLE组76例，OE组115例，采用单因素方差分析、Kruskal-Wallis检验、矿检验以及方差分割法比较3组问的一般临床资料、围手术期恢复相关指标、淋巴结清扫数目以及术后并发症之间的差异。结果：在术中出血量、重症监护时间和首次下床站立时间方面，3组间差异有统计学意义，两两比较TLE组要显著优于0E组（P〈0．0125）。淋巴结清扫总数3组间差异无统计学意义，但对于食管上段淋巴结区域，TLE组要优于OLE和OE组（P〈0．001）。虽然外科系统总并发症发生率3组相当，但喉返神经损伤TLE组要显著高于OLE和OE组（P=0．012，0．003）。术后发生重症呼吸循环系统并发症方面，3组间差异有统计学意义，两两比较TLE组发生率显著低于OLE和OE组（P〈0．0125）。术后第1、3天全身炎症反应综合征（systemic inflammatory response syndrome, SIRS）发生率TLE组均低于OLE和OE组（P〈0．0125）。结论：胸腹腔镜联合食管癌切除与传统开放手术比较是安全可行的，同时具有创伤小、术后恢复快、并发症少等优点，淋巴结清扫与传统开胸手术相当，但对于上纵隔区喉返神经旁区域淋巴结清扫效果更佳。
Background and purpose： The traditional 3 incision surgery is an important means of esophageal cancer treatment, however, accompanied by more postoperative complications and higher mortality. Minimally invasive esophagectomy is a prospective technology with advantages, such as little trauma and quick recovery. This study retrospectively analyzed the perioperative effect of the esophagus cancer patients who accepted thoracoscopic- laparoscopic esophagectomy （TLE）, open-laparoscopic esophagectomy （OLE） and open esophagectomy （OE） from Jan. 2013 to Jan. 2015. Methods： In this study, 72 patients received TLE, 76 patients received OLE and 115 patients received OE, respectively. One-way ANOVA, Kruskal Wallis test and Chi-square test were used to compare the differences of general clinical data, perioperative recover index, the number of lymphadenectomy and the postoperative complication among TLE, OLE and OE. Results： There were differences in the area of operative blood loss, duration of ICU stay and first standing time among the 3 groups. Pairwise comparison demonstrated that TLE group was significantly better than OE group （P〈0.012 5）. The total number of lymphadenectomy among the 3 groups had no differences. However, the number of lymph node of the upper esophagus in the TLE groups was more than those in OLE group and OE group （P〈0.001）. The laryngeal recurrent nerve injury incidence in TLE group was significantly higher than those in OLE group and OE group （P=0.012, 0.003）. The total surgical complication had no differences among 3 groups. In areas of the cardiorespiratory system severe complication, 3 groups had statistical differences. Pairwise comparison showed TLE group was significantly less than OLE and OE group （P〈0.0125）. The first day and third day incidences of SIRS rate in TLE group were less than those in OLE group and OE group （P〈0.0125）. Conclusion： Comparing to OE group, with the same safety and feasibility, TLE had more advantages such as trauma, quic
出处
《中国癌症杂志》
CAS
CSCD
北大核心
2016年第11期932-938,共7页
China Oncology
关键词
食管癌
外科治疗
胸腔镜
腹腔镜
Esophageal cancer
Surgical treatment
Thoracoscope
Laparoscopy
