单孔充气式纵隔镜辅助经裂孔食管切除术与功能性微创食管癌切除术治疗食管癌的倾向性评分匹配研究  

Single-port inflatable mediastinoscope-assisted transhiatal esophagectomy versus functional minimally invasive esophagectomy for esophageal cancer:A propensity score matching study

作　　者：王谦 刘慧兵 张鲁昌 靳德峰 崔昭庆 倪海洋 魏育涛 WANG Qian;LIU Huibing;ZHANG Luchang;JIN Defeng;CUI Zhaoqing;NI Haiyang;WEI Yutao(Department of Thoracic and Cardiovascular Surgery,Nantong No.1 People’s Hospital,Nantong,226000,Jiangsu,P.R.China;School of Clinical Medicine,Jining Medical University,Jining,272000,Shandong,P.R.China;Department of Thoracic Surgery,Jining No.1 People’s Hospital,Jining,272000,Shandong,P.R.China;Institute of Thoracic Surgery,Jining Institute of Medical Sciences,Jining,272000,Shandong,P.R.China)

机构地区：[1]南通第一人民医院胸心血管外科,江苏南通226000 [2]济宁医学院临床医学院,山东济宁272000 [3]济宁市第一人民医院胸外科,山东济宁272000 [4]济宁医学科学研究所胸部外科疾病研究所,山东济宁272000

出　　处：《中国胸心血管外科临床杂志》2024年第11期1625-1631,共7页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的比较纵隔镜辅助经裂孔食管切除术(mediastinoscope-assisted transhiatal esophagectomy,MATHE)和功能性微创食管癌切除术(functional minimally invasive esophagectomy,FMIE)治疗食管癌的疗效。方法回顾性纳入2018年3月—2022年9月在济宁市第一人民医院行腔镜微创食管鳞状细胞癌切除术患者,根据手术方式将患者分为MATHE组和FMIE组。采用倾向性评分匹配(propensity score matching,PSM),按1∶1比例匹配,卡嵌值设置为0.2。比较匹配后两组患者的临床资料。结果共纳入患者73例,其中男54例、女19例,平均年龄(65.12±7.87)岁。MATHE组37例,FMIE组36例,经PSM后,两组各纳入30例。与FMIE组相比,MATHE组手术时间更短(P=0.022),术后24 h疼痛评分更低(P=0.031),术后第1~3天引流量更少(P<0.001)。FMIE组淋巴结清扫数量更多(P<0.001),术后声音嘶哑发生率更低(P=0.038),术后第1天白细胞计数、中性粒细胞计数更少(P<0.001)。MATHE组与FMIE组在术中出血量、R0切除、住院死亡率、术后住院时间、吻合口漏、乳糜胸、肺部感染方面差异无统计学意义(P>0.05)。结论与FMIE相比,MATHE手术时间更短、术后疼痛更轻、引流量更少,但淋巴结清扫数量更少,在肿瘤学角度上仍是有欠缺的。对于一些早期癌症或广泛胸膜粘连等特殊患者,MATHE可能是比较好的手术方式。Objective To compare the efficacy of mediastinoscope-assisted transhiatal esophagectomy(MATHE)and functional minimally invasive esophagectomy(FMIE)for esophageal cancer.Methods Patients who underwent minimally invasive esophagectomy at Jining No.1 Hospital from March 2018 to September 2022 were retrospectively included.The patients were divided into a MATHE group and a FMIE group according to the procedures.The patients were matched via propensity score matching(PSM)with a ratio of 1:1 and a caliper value of 0.2.The clinical data of the patients were compared after the matching.Results A total of 73 patients were include in the study,including 54 males and 19 females,with an average age of(65.12±7.87)years.There were 37 patients in the MATHE group and 36 patients in the FMIE group.Thirty pairs were successfully matched.Compared with the FMIE group,MATHE group had shorter operation time(P=0.022),lower postoperative 24 h pain score(P=0.031),and less drainage on postoperative 1-3 days(P<0.001).FMIE group had more lymph node dissection(P<0.001),lower incidence of postoperative hoarseness(P=0.038),lower white blood cell and neutrophil counts on postoperative 1 day(P<0.001).There was no statistically significant difference in the bleeding volume,R0 resection,hospital mortality,postoperative hospital stay,anastomotic leak,chylothorax,or pulmonary infection between the two groups(P>0.05).Conclusion Compared with the FMIE,MATHE has shorter operation time,less postoperative pain and drainage,but removes less lymph nodes,which is deficient in oncology.For some special patients such as those with early cancer or extensive pleural adhesions,MATHE may be a suitable surgical method.

关 键 词：食管癌 微创食管癌切除术 纵隔镜 倾向性评分匹配 

分 类 号：R735.1[医药卫生—肿瘤]