传统开胸及全腔镜切除术对早中期食管癌的疗效比较  

Clinical comparison of conventional open surgery versus total esophagectomy for early and middle-stage esophageal cancer

作　　者：张建华 薛军英 王继超 杨锦 王林佩 ZHANG Jianhua;XUE Junying;WANG Jichao(Department of Cardiothoracic Surgery,The Second People’s Hospital of Hengshui,Hebei,Hengshui 053000,China;不详)

机构地区：[1]河北省衡水市第二人民医院心胸外科,053000 [2]河北省衡水市第三人民医院肺病科

出　　处：《河北医药》2023年第6期845-848,共4页Hebei Medical Journal

基　　金：衡水市重点研发计划(编号:2020014033Z)。

摘　　要：目的 探讨传统开胸及全腔镜早中期食管癌切除术对胸中段食管癌患者临床疗效的影响,为两项技术的临床应用提供经验。方法 选取2019年1月至2021年1月收治的早中期胸中段食管癌71例,根据手术方式分为传统开胸手术组35例和全腔镜切除术组36例,比较2组术前、术中及术后心率(HR)、平均动脉压(MAP)、血氧饱和度(SPO_(2))、中心静脉压(CVP)、呼气末二氧化碳分压(PET-CO_(2))和pH值的差异,并比较2组短期疗效、淋巴结清扫情况和并发症发生率。结果 全腔镜切除术组术中HR、PET-CO_(2)均低于传统开胸手术组,术后HR高于传统开胸手术组,CVP、pH值低于传统开胸手术组(P<0.05)。全腔镜切除术组术中出血量、拔管时间均低于传统开胸手术组(P<0.05)。全腔镜切除术组胸部淋巴结总数、喉返神经旁淋巴结数、喉返神经旁淋巴结阳性数均高于传统开胸手术组(P<0.05)。全腔镜切除术组术后并发症总发生率为16.67%低于传统开胸手术组的40.00%(P<0.05)。结论 全腔镜切除术在早中期食管癌的临床治疗中安全性较传统开胸手术更高,可明显减少患者术中出血量,提高胸部淋巴结、喉返神经旁淋巴结清扫率,降低术后并发症。Objective To explore the therapeutic efficacy of conventional open surgery versus total esophagectomy on the early and middle-stage esophageal cancer,and to provide experiences for their clinical application.Methods A total of 71 patients with early and middle-stage esophageal cancer admitted from January 2019 to January 2021 were selected as research subjects.They were assigned to conventional open surgery group(n=35)and total esophagectomy group(n=36)according to the surgical method.Preoperative,intraoperative and postoperative heart rate(HR),mean arterial pressure(MAP),systemic oxygen saturation(SpO 2),central venous pressure(CVP),end-tidal partial pressure of CO 2(PetCO 2),pH value between the two groups were compared;the short-term efficacy,lymph node cleaning,rate of complications were assessed.Results Intraoperative HR and PetCO 2 and postoperative CVP and pH in total esophagectomy group were significantly lower than those in conventional open surgery group,while the postoperative HR was significantly higher(all P<0.05).Intraoperative blood loss and duration of indwelling in total esophagectomy group were significantly lower than those in conventional open surgery group(both P<0.05).The total number of thoracic lymph nodes,the number of lymph nodes next to the recurrent laryngeal nerve,and the number of positive lymph nodes next to the recurrent laryngeal nerve in total esophagectomy group were significantly higher than those in conventional open surgery group(all P<0.05).The incidence of postoperative complications in total esophagectomy group was significantly lower than that in conventional open surgery group(16.67%vs 40.00%,P<0.05).Conclusion Total esophagectomy is safer than that of conventional open surgery for the treatment of early and middle-stage esophageal cancer,which can significantly reduce the intraoperative bleeding volume,improve the chest lymph node and recurrent laryngeal lymph node dissection rate,and reduce postoperative complications.

关 键 词：胸中段食管癌 传统开胸手术 全腔镜切除术 安全性 

分 类 号：R735.1[医药卫生—肿瘤]