改良式上腹右胸两切口术治疗中下段食管癌的临床应用价值研究  

Clinical value of modified upper abdomen and right thoracotomy in the treatment of middle and lower esophageal cancer

作　　者：彭勇 杨健 许经伟 郁喆 戴春雷 徐卫华[2] PENG Yong;YANG Jian;XU Jing-wei(Department of Thoracic and Cardiac Surgery,Suzhou Hospital Affiliated to Nanjing Medical University (Suzhou State Hospital,Suzhou Jiangsu 215000,China)

机构地区：[1]南京医科大学附属苏州医院(苏州市立医院)本部胸心外科,江苏苏州215000 [2]苏州大学附属第二医院胸心外科,江苏苏州215004

出　　处：《临床和实验医学杂志》2019年第22期2435-2438,共4页Journal of Clinical and Experimental Medicine

基　　金：江苏省青年医学人才基金(编号:QNRC2016740)

摘　　要：目的探讨改良式上腹右胸两切口术治疗中下段食管癌患者的临床效果及价值。方法采用回顾性研究方法,选取2016年2月至2019年2月南京医科大学附属苏州医院和苏州大学附属第二医院收治的62例中下段食管癌患者,按治疗方式的不同将患者分为两组:行左开胸术治疗30例患者作为对照组,行改良式上腹右胸两切口术治疗的32例患者作为研究组。分析相关手术指标、患者细胞免疫功能变化、并发症发生情况、治疗满意度评分等。结果研究组患者的淋巴结清扫数目(15.95±2.63枚)显著多于对照组(10.24±3.28枚),患者术后平均住院时间(20.53±2.21 d)显著短于对照组(26.88±4.46 d),差异具有统计学意义(t=7.585、7.172,P<0.05);研究组患者的手术时间(219.83±50.51 min)、术中出血量(213.32±35.62 ml)、带鼻胃管时间(6.86±1.64 d)与对照组(220.57±46.25 min,216.74±38.73 ml,6.88±1.58 d)比较,差异均无统计学意义(t=0.060、0.362、0.048,P>0.05);术后5 d,研究组患者的CD4+(37.97±3.18%)及CD4^+/CD8^+(1.79±0.16%)水平均显著高于对照组(35.18±2.62%,1.41±0.15%),差异具有统计学意义(t=3.756、9.631,P<0.05);研究组患者的术后并发症总发生率(9.38%)明显低于对照组(30.00%),差异具有统计学意义(χ^2=4.219,P<0.05);研究组患者的治疗满意度评分(87.84±5.38分)明显高于对照组(70.73±3.73分),差异具有统计学意义(t=14.460,P<0.05)。结论给予中下段食管癌患者改良式上腹右胸两切口术治疗,可更彻底地清扫淋巴结,对细胞免疫功能影响更小,并能减少术后并发症,缩短患者康复时间。Objective To evaluate the clinical effect and value of modified upper abdomen and right thoracic incision in the treatment of middle and lower esophageal cancer.Methods Sixty-two patients with middle and lower esophageal cancer who were admitted to Suzhou Hospital Affiliated to Nanjing Medical Universityl from February 2016 to February 2019 were divided into two groups according to the treatment methods,thirty patients were treated with left thoracotomy as control group,thirty-two patients who underwent modified upper abdominal and right thoracic incisions were selected as the study group.Relevant surgical indicators,changes of cellular immune function and complications,treatment Satisfaction Score were retrospectively analyzed.Results The number of lymph node dissection in the study group(15.95±2.63)was significantly more than that in the control group(10.24±3.28),the average hospitalization time of the patients after operation(20.53±2.21 d)was significantly shorter than that of the control group(26.88±4.46 d),the difference was statistically significant(t=7.585,7.172,P<0.05).The operation time(219.83±50.51 min),intraoperative bleeding volume(213.32±35.62 ml),nasogastric tube time(6.86±1.64 d)in the study group were compared with those in the control group(220.57±46.25 min,216.74±38.73 ml,6.88±1.58 d),there was no significant difference between the two groups(t=0.060,0.362,0.048,P>0.05).Five days after operation,the levels of CD4+(37.97±3.18%)and CD4^+/CD8^+(1.79±0.16%)in the study group were significantly higher than those in the control group(35.18±2.62%)and 1.41±0.15%),the difference was statistically significant(t=3.756,9.631,P<0.05).The total incidence of postoperative complications in the study group(9.38%)was significantly lower than that in the control group(30.00%)(χ^2=4.219,P<0.05).The treatment satisfaction score of the study group was(87.84±5.38),which was significantly higher than that of the control group(70.73±3.73)(t=14.460,P<0.05).Conclusion The patients with middle and lower es

关 键 词：中下段食管癌 改良式上腹右胸两切口术 左开胸术 免疫功能 

分 类 号：R735.1[医药卫生—肿瘤]