开放手术与腔镜下根治切除术治疗胸段食管鳞癌的病例对照研究  

Thoracolaparoscopic versus open approach for thoracic esophageal squamous cell carcinoma:A case control study

作　　者：邹志强[1] 袁耒[1] 胡凤标[1] 隋刚[1] 刘玉[1] 

机构地区：[1]济南军区总医院胸外科,济南250031

出　　处：《中国胸心血管外科临床杂志》2018年第1期78-82,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的对比胸段食管鳞癌行胸、腹腔镜根治切除术与开放手术的安全性及手术效果。方法回顾性分析2014年6月到2015年6月我科125例胸段食管鳞癌患者的临床资料,其中经左颈、右胸、上腹行食管癌切除+食管胃颈部吻合术(Mc Keown术)18例(开放组,男13例、女5例),行腔镜下Mc Keown术107例(腔镜组,男77例、女30例),比较两组患者手术资料及术后并发症情况。结果腔镜组手术时间、住ICU时间、喉返神经旁淋巴结清扫个数与开放组[(333.58±72.84)min vs.(369.17±91.24)min,P=0.067;(2.84±1.44)d vs.(6.44±13.46)d,P=0.272;(4.71±3.87)个vs.(3.89±3.97)个,P=0.408]差异均无统计学意义。腔镜组术中出血量少于开放组[(222.62±139.77)ml vs.(427.78±276.65)ml,P=0.006]。腔镜组淋巴结清扫总数、淋巴结组数多于开放组[(19.62±9.61)个vs.(14.61±8.07)个,P=0.038;(3.70±0.99)组vs.(3.11±1.13)组,P=0.024],差异具有统计学意义。腔镜组总并发症发生率为32.7%,开放组38.9%,差异无统计学意义(P=0.608)。腔镜组肺部感染率明显低于开放组(2.8%vs.16.7%),差异具有统计学意义(P=0.011)。两组吻合口瘘、心脏并发症、左侧胸腔积液、右侧气胸、声音嘶哑、切开感染发生率差异均无统计学意义。结论与开放手术相比,针对胸段食管鳞癌行腔镜下Mc Keown术清扫淋巴结彻底、出血量少,肺部感染发生率优于开放手术,符合食管癌切除安全性和肿瘤根治性原则。Objective To evaluate the security and outcomes of thoracolaparoscopic esophagectomy（TLE）versus open approach（OA） for thoracic esophageal squamous cell carcinoma.Methods From June 2014 to June 2015,125 patients with thoracic esophageal squamous cell carcinoma underwent esophagectomy through Mc Keown approach,including TLE（a TLE group,107 patients,77 males and 30 females） and OA（an OA group,18 patients,13 males and5 females）.The data of operation and postoperative complications of the two groups were analyzed retrospectively.Results There was no statistical difference in the duration of operation and ICU stay and resected lymph nodes around laryngeal recurrent nerve between the TLE group and the OA group（333.58±72.84 min vs.369.17±91.24 min,P=0.067;2.84±1.44 d vs.6.44±13.46 d,P=0.272：4.71±3.87 vs.3.89±3.97,P=0.408）.There was a statistical difference in blood loss,total resected lymph nodes and resected lymph nodes groups between TLE group and OA group（222.62±139.77 ml vs.427.78±276.65,P=0.006：19.62±9.61 vs.14.61±8.07,P=0.038：3.70±0.99 vs.3.11±1.13,P=0.024）.The rate of postoperative complications was 32.7% in the TLE group and 38.9% in the OA group（P=0.608）.There was a statistical difference（P=0.011） in incidence of pulmonary infection（2.8% in the TLE group and 16.7% in the OA group）.Incidences of complications,such as anastomotic leakage,cardiac complications,left-side hydrothorax,right-side pneumothorax,voice hoarse and incision infection,showed no statistical difference between two groups.Conclusion For patients with thoracic esophageal squamous cell carcinoma,TLE possesses advantages of more harvested lymph nodes,less blood loss and less pulmonary infection comparing with open approach,and is complied with the principles of security and oncological radicality of surgery.

关 键 词：胸段食管鳞癌 微创食管癌切除术 淋巴结清扫 

分 类 号：R735.1[医药卫生—肿瘤]