胸腹腔镜微创手术与传统开胸手术治疗食管癌的临床疗效对比分析  

Comparative analysis of clinical efficacy of thoracoscopic and laparoscopic minimally invasive surgery and traditional thoracotomy in the treatment of esophageal carcinoma

作　　者：张强[1] 李学灿[1] 李俊杰 张习文 徐恒 ZHANG Qiang;LI Xuecan;LI Junjie;ZHANG Xiwen;XU Heng(Department of Oncology,Jiaozuo People’s Hospital,Jiaozuo 454000,He’nan,China)

机构地区：[1]焦作市人民医院肿瘤外科,河南焦作454000

出　　处：《癌症进展》2020年第22期2337-2340,共4页Oncology Progress

摘　　要：目的探讨胸腹腔镜微创手术与传统开胸手术治疗食管癌的临床疗效。方法根据手术方式的不同将100例食管癌患者分为腔镜组(n=52)和开胸组(n=48),腔镜组患者采用胸腹腔镜微创手术,开胸组患者采用传统开胸手术。比较两组患者的围手术期指标、术后并发症发生率、术前及术后1周的血清肿瘤标志物[癌胚抗原(CEA)、鳞状细胞癌抗原(SCC-Ag)、细胞角质蛋白19片段抗原21-1(CYFRA21-1)]水平,比较两组患者术后1周内再次手术及住入重症监护室(ICU)情况,以及随访1年的复发、转移和生存情况。结果腔镜组患者的手术时间明显长于开胸组,术中出血量及术后引流量均明显少于开胸组,术后36 h疼痛评分明显低于开胸组,差异均有统计学意义(P﹤0.01)。术后腔镜组患者吻合口瘘、喉返神经损伤、肺不张与肺部感染、胃排空延迟的发生率均低于开胸组(P﹤0.05)。术前及术后1周,两组患者的血清CEA、SCC-Ag、CYFRA21-1水平比较,差异均无统计学意义(P﹥0.05);术后1周,两组患者的血清CEA、SCC-Ag、CYFRA21-1水平均低于本组术前,差异均有统计学意义(P﹤0.05)。术后1周内腔镜组中再次手术及入住ICU的患者比例均低于开胸组(P﹤0.05)。两组患者术后1年的复发或转移率及生存情况比较,差异均无统计学意义(P﹥0.05)。结论与传统开胸手术相比,胸腹腔镜微创手术治疗食管癌安全可行,手术效果理想,同时具有创伤小、患者恢复快、并发症少等优势。Objective To investigate the clinical efficacy of thoracoscopic and laparoscopic minimally invasive surgery and traditional thoracotomy in the treatment of esophageal carcinoma.Method 100 patients with esophageal carcinoma were divided into endoscopy group(n=52)and thoracotomy group(n=48).Patients in the endoscopy group were treated with thoracoscopic and laparoscopic minimally invasive surgery,while patients in the thoracotomy group were treated with traditional thoracotomy.Perioperative indicators,postoperative complications,serum tumor markers[carcinoembryonic antigen(CEA),squamous cell carcinoma antigen(SCC-Ag),cyto-keratin 19 fragment antigen 21-1(CYFRA 21-1)]levels before and one week after operation were compared between the two groups.The reoperation and hospitalization in intensive care unit(ICU)within one week after operation were compared between the two groups,as well as the recurrence,metastasis and survival during one year follow-up.Result The operation time in the endoscopy group was longer than that in the thoracotomy group,the intraoperative blood loss and postoperative drainage volume were lower than those in the thoracotomy group,and the pain score at 36 hours after operation was lower than that in the thoracotomy group(P<0.01).The incidence rate of anastomotic leakage,recurrent laryngeal nerve injury,atelectasis and pulmonary infection and delayed gastric emptying in the endoscopy group was lower than that in the thoracotomy group(P<0.05).There was no significant difference in serum CEA,SCC-Ag and CYFRA21-1 levels between the two groups before operation and one week after operation(P>0.05).One week after operation,the levels of serum CEA,SCC-Ag and CYFRA21-1 in the two groups were lower than those before operation,and the differences were statistically significant(P<0.05).One week after operation,the proportion of patients who were reoperated and admitted to ICU in endoscopy group was lower than that in thoracotomy group(P<0.05).One year after operation,there was no significant difference betw

关 键 词：食管癌 胸腹腔镜微创手术 开胸手术 并发症 肿瘤标志物 

分 类 号：R735.1[医药卫生—肿瘤]