新辅助同步放化疗联合食管癌腔镜三切口手术的临床疗效  

Clinical effect of neoadjuvant chemo-radiation combined with thoracoscopic and laparoscopic three-incision esophagectomy

作　　者：赵亮[1] 赵格非[1] 李嘉根[1] 高树庚[1] 薛奇[1] 

机构地区：[1]国家癌症中心/中国医学科学院北京协和医学院肿瘤医院胸外科,北京100021

出　　处：《中华消化外科杂志》2017年第5期469-473,共5页Chinese Journal of Digestive Surgery

基　　金：首都医学发展科研基金（首发2014-1-4021）

摘　　要：目的探讨新辅助同步放化疗联合食管癌腔镜三切VI手术的临床疗效及新辅助同步放化疗与手术的安全间隔时间。方法采用回顾性队列研究方法。收集2010年1月至2016年12月中国医学科学院北京协和医学院肿瘤医院收治的111例行新辅助同步放化疗联合食管癌腔镜三切口手术患者的临床病理资料。68例患者新辅助同步放化疗与食管癌胸腹腔镜联合三切口手术间隔时间〈8周，设为〈8周组；43例患者新辅助同步放化疗与食管癌胸腹腔镜联合三切口手术间隔时间≥8周，设为≥8周组。患者术前行放疗，同期采用TP方案行化疗。放化疗结束后择期行食管癌胸腹腔镜联合三切口手术。观察指标：（1）新辅助同步放化疗情况。（2）手术及术后情况。（3）随访情况。采用门诊和电话方式进行随访，了解患者术后生存和肿瘤复发、转移情况。随访时间截至2017年3月。正态分布的计量资料以x±s表示，组间比较采用t检验；计数资料比较采用疋。检验或Fisher确切概率法；等级资料比较采用非参数检验。结果（1）新辅助同步放化疗情况：〈8周组和／〉8周组患者均按疗程完成新辅助同步放化疗．无严重不良反应发生。〈8周组和≥8周组患者肿瘤病理学完全缓解例数分别为34例和15例．两组比较．差异无统计学意义（X2=2．441，P〉O．05）。（2）手术及术后情况：〈8周组和≥8周组患者均顺利完成手术，手术切缘均为阴性。〈8周组和≥8周组患者手术时间、术中出血量、淋巴结清扫数目、术后胸腔引流管拔除时间、术后颈部引流管拔除时间、声音嘶哑、上消化道出血、吻合口瘘、呼吸系统并发症、胸腔积液或积脓、心血管系统并发症、切口愈合不良、术后30d内死亡、术后住院时间分别为（354±103）min和（343±92）min、（400±76）mL和（392±51）mL、（19±4）枚和（19±3）枚Objective To explore the clinical effect of neoadjuvant chemo-radiation combined with thoracoscopic and laparoseopic three-incision esophageetomy for esophageal cancer. Methods The retrospective cohort study was conducted. The elinieopathological data of 111 esophageal cancer patients who underwent neoadjuvant chemo-radiation combined with thoraeoseopic and laparoscopic three-incision esophageetomy in the Cancer Hospital of Chinese Academy of Medical Sciences between January 2010 and December 2016 were collected. Among 111 patients, 68 with interval time between neoadjuvant chemo-radiation and thoracoscopic and laparoscopic three-incision esophagectomy 〈 8 weeks were allocated into the 〈 8 weeks group and 43 with interval time between neoadiuvant chemo-radiation and thoracoscopic and laparoseopic three-incision esophagectomy 〉 8 weekswere allocated into the I〉 8 weeks group. Patients underwent preoperative radiotherapy and chemotherapy with TP regimen, and then underwent selective thoracoseopie and laparoscopic three-incision esophagectomy. Observation indicators ： （ 1 ） neoadjuvant chemo-radiation situations ; （2） surgical and postoperative situations ; （3） follow-up. Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival of patients and tumor recurrence or metastasis up to March 2017. Measurement data with normal distribution were represented as x±s and comparison between groups was analyzed using the t test. Count data were analyzed using the chi-square test or Fisher exact probability. Comparison of ranked data was done by the nonparametric test. Results （1） Neoadjuvant chemo-radiation situations： all the patients underwent neoadjuvant chemo-radiation, without severe adverse reaction. Number of patients with complete remission based on oncopathology were 34 in the 〈8 weeks group and 15 in the 〉18 weeks group, with no statistically significant difference between the 2 groups （X2= 2.441, P〉 0.05）. （2） Surgical and

关 键 词：食管肿瘤 手术切除 三切口 新辅助同步放化疗 胸腔镜检查 腹腔镜检查 

分 类 号：R735.1[医药卫生—肿瘤]