胸腔镜联合腹腔镜辅助下Ⅱ、Ⅲ期食管癌切除二野淋巴结清扫临床研究  

Clinical Study of Thoracoscopic Combined with Laparoscopic Assistedin the Resection of Stage Ⅱ and Ⅲ Esophageal Cancer with Two-field Lymph Node Dissection

作　　者：钟钏[1] 胡杰伟[1] 周海宁[1] 杨胜利 Zhong Chuan;Hu Jiewei;Zhou Haining(Department of Thoracic Surgery,Suining Central Hospital,Suining,Sichuan 629000,China)

机构地区：[1]遂宁市中心医院胸外科,四川遂宁629000 [2]中山大学附属佛山医院胸外科,广东佛山528000

出　　处：《四川医学》2018年第8期891-895,共5页Sichuan Medical Journal

摘　　要：目的通过对胸腔镜联合腹腔镜辅助下与传统开放三切口这两种手术方式在Ⅱ、Ⅲ期食管癌行切除+二野淋巴结清扫中的临床效果对比,研究分析胸腔镜联合腹腔镜辅助下方法的治疗优势,以期为治疗Ⅱ、Ⅲ期食管癌行切除+二野淋巴结清扫患者提供更好的途径。方法回顾性分析2012年1月至2016年7月在本院行食管癌切除+二野淋巴结清扫的Ⅱ、Ⅲ期食管癌患者112例,按手术方式分为对照组(58例),实验组(54例),对照组行传统开放三切口食管癌切除术,实验组行胸腔镜联合腹腔镜辅助下切除术,对比分析(1)实验组、对照组患者性别、年龄、病史、是否吸烟等;(2)实验组、对照组患者手术时间、出血量、清扫淋巴结数目及术后住院时间等;(3)术后并发症:出血、肺部感染、声音嘶哑、胸腔积液、心律失常、动静脉血栓等。(4)实验组对照组炎症细胞因子IL-6、IL-8、IL-10、TNF-α术前后浓度变化。结果实验组、对照组患者病史、是否吸烟等一般资料差异无统计学意义(P>0. 05);实验组手术时间(278±45) min、出血量(218±127) mL均少于对照组(291±39) min、(241±136) mL,差异有统计学意义(P<0. 05);实验组清扫淋巴结数目(22. 28±5. 9)个高于对照组(20. 67±5. 8)个,差异有统计学意义(P<0. 05);实验组术后出现肺部感染(20. 4%)、声音嘶哑(11. 1%)及心律失常(3. 7%)比例均小于对照组(38. 1%)、(22. 4%)、(10. 3%),差异有统计学意义(P<0. 05);两组出现出血、胸腔积液、动静脉血栓等比例差异无统计学意义(P>0. 05);术后实验组IL-6、IL-10、TNF-α因子浓度(2. 13±1. 25) pg/mL、(0. 55±0. 42)pg/mL、(1. 63±0. 85) ng/mL与对照组(2. 96±1. 64) pg/mL、(0. 78±0. 53) pg/mL、(2. 67±1. 45) ng/mL相比差异有统计学意义(P<0. 05)。结论胸腔镜联合腹腔镜辅助下Ⅱ、Ⅲ期食管癌切除+二野淋巴结清扫术较传统手术有较为明显的微创优势,术后并发症发生率也少�Objective To compare the clinical effects of thoracoscopic combined with laparoscopic assisted and conventional open three-incision in the resection of stage Ⅱ and Ⅲ esophageal cancer with two-field lymph node dissection.To study and analyze the therapeutic advantages of thoracoscopic combined with laparoscopic-assisted method so as to provide a better way to treat patients with stage Ⅱ and Ⅲ esophageal cancer resection and two-field lymph node dissection.Methods A retrospective analysis of 112 patients with stage Ⅱ and Ⅲ esophageal cancer who underwent esophageal cancer resection and two-field lymph node dissection from January 2012 to July 2016 was taken.All patients were divided into control group（ 58 cases） and experimental group（ 54 cases） by surgical approach.The control group underwent traditional open three-incision esophageal cancer resection,the experimental group underwent thoracoscopic combined with laparoscopic assisted resection.We compared these indexes between the experimental group and control group.（1）The gender,age,medical history,smoking or not,etc.（2）The operation time,blood loss,number of lymph nodes dissection and postoperative hospital stay.（3）The postoperative complications： hemorrhage,pulmonary infection,hoarseness,pleural effusion,arrhythmia,arteriovenous thrombosis.（4） The concentration changes of inflammatory cytokines IL-6,IL-8,IL-10 and TNF-α before and after operation.Results There was no significant difference in the general data such as medical history and smoking between the experimental group and the control group（ P〉0.05）. The operation time（ 278 ± 45） min and the blood loss（ 218±127） mL were lower in the experimental group than in the control group,（ 291±39） min,（ 241±136） mL,the difference was statistically significant（ P〈0.05）. The number of lymph nodes dissection in the experimental group（ 22. 28 ± 5. 9） was higher than that of the control group（ 20. 67±5. 8）,the difference was statistically s

关 键 词：胸腔镜联合腹腔镜 开胸联合开腹食管癌切除 二野淋巴结清扫 食管癌 

分 类 号：R735.1[医药卫生—肿瘤]