胸腔镜食管癌切除联合左侧颈部吻合治疗食管癌的疗效及其对呼吸功能的影响  

Efficacy of thoracoscopic radical esophagectomy combined with left cervical anastomosis in the treatment of esophageal carcinoma and its influence on respiratory function

作　　者：夏漫辉[1] 冷云华[1] 季灿平[1] 丁学武[1] 陈佳杰 XIA Manhui;LENG Yunhua;JI Canping(Department of Chest Surgery,Jingjiang People Hospital,Jingjiang,Jiangsu 214500,China)

机构地区：[1]江苏省靖江市人民医院心胸外科,214500

出　　处：《临床外科杂志》2020年第8期760-763,共4页Journal of Clinical Surgery

基　　金：江苏省卫生计生委科研课题资助项目(YG201511)。

摘　　要：目的研究胸腔镜食管癌切除联合左侧颈部吻合治疗食管癌的疗效,并分析其对呼吸功能的影响。方法2013年1月~2016年1月间收治的食管癌病人256例,按照病人意愿将其分为两组,胸腔镜组163例,采用胸腔镜食管癌根治术+左侧颈部吻合;传统组93组,采用常规经右胸食管癌切除+胃食管胸内吻合。比较两组治疗效果及对呼吸功能的影响。结果胸腔镜组手术时间显著长于传统组,术中出血量少于传统组,差异有统计学意义(P<0.05)。两组淋巴结清扫个数比较差异无统计学意义(P>0.05);胸腔镜组术后脉搏血氧饱和度(SpO2)水平高于传统组,呼吸频率(RR)与分钟通气量(MV)低于传统组,差异有统计学意义(P<0.05);两组疼痛程度在术后12小时、24小时、48小时及72小时均呈依次降低趋势,组内比较差异有统计学意义(P<0.05),且术后各时段胸腔镜组疼痛程度均显著低于传统组(P<0.05);胸腔镜组术后总引流量显著少于传统组,右上肢功能恢复时间、术后拔管时间及术后住院时间均短于传统组差异有统计学意义(P<0.05);胸腔镜组术后并发症率显著低于传统组,差异有统计学意义(P<0.05);随访3年,两组食管癌复发率、死亡率比较,差异无统计学意义(P>0.05)。结论胸腔镜食管癌切除联合左侧颈部吻合具有微创优势,能减轻食管癌病人疼痛程度,对病人呼吸功能影响较小,有利于病人术后恢复,病人远期预后无明显差异,但手术操作复杂,适应证有限,不能完全替代开放性手术。Objective To investigate the efficacy of thoracoscopic radical esophagectomy combined with left cervical anastomosis in the treatment of patients with esophageal cancer,and analyze its effect on the effect on the respiratory function of patients.Methods 256 patients with esophageal cancer admitted to our hospital from January 2013 to January 2016 were enrolled,and divided into two groups according to their willingness.The thoracoscopic group(n=163)and the traditional group(n=93)received received thoracoscopic radical esophagectomy plus left cervical anastomosis and thoracic esophageal resection plus gastroesophageal intrathoracic anastomosis,respectively.Then the clinical efficacy was compared between the two groups.Results The operation time of the thoracoscopy group was significantly longer than that of the traditional group,and the intraoperative blood loss was significantly less than the traditional group(both P<0.05).There was no significant difference in the number of lymph node dissection between the two groups(P>0.05).The postoperative pulse oximetry(SpO2)level in the thoracoscopy group was significantly higher than that in the traditional group,respiratory rate(RR)and minute ventilation(MV)level was significantly lower than the traditional group(both P<0.05).The pain degrees showed a decreasing trend in both groups at the postoperative after 12 h,24 h,48 h and 72 h,with statistic difference between groups(P<0.05).The total drainage volume in the thoracoscopic group was significantly less than that in the traditional group,and the recovery time of the right upper limb function,postoperative extubation time and postoperative hospital stay were significantly shorter than the traditional group(P<0.05).The postoperative complication rate of the thoracoscopy group was significantly lower than the traditional group(P<0.05).After 3 years of follow-up,the recurrence rate of esophageal cancer in both groups and mortality rate had no significant differences were observed between the two groups(P>0.05).Conclusion Ap

关 键 词：胸腔镜根治术 颈部吻合 食管癌 疗效 呼吸功能 

分 类 号：R735.1[医药卫生—肿瘤]