| 摘要: |
| ［摘要］ 目的 通过与开放手术比较，探讨胸腹腔镜联合食管癌切除术在食管癌外科治疗中的安全性及远期疗效。方法 选取2014-03～2018-06河南省安阳市肿瘤医院胸外科收治的544例食管鳞状细胞癌患者进行研究，胸腹腔镜组（thoracoscopic and laparoscopic esophagectomy,TLE）122例，采用倾向评分匹配分析法，一对一匹配开放组（open esophagectomy,OE）122例。手术方法均采取McKeown术式。收集围手术期相关指标，随访1～3年生存情况。结果 倾向评分匹配后，TLE组较OE组术中出血量少，术后住院时间短，心肺并发症少，总并发症发生率低，淋巴结清扫数目多，差异均有统计学意义（P<0.05）。两组患者在手术时间、术后胸液量、吻合口瘘、乳糜胸、30 d住院死亡率方面，差异无统计学意义（P>0.05）。TLE组1年、2年、3年生存率分别为95.1%、74.6%、57.4%，OE组分别为94.3%、70.5%、47.5%，3年累积生存率差异无统计学意义(P=0.095)。结论 胸腹腔镜联合食管癌切除术安全、可靠，较开放手术可显著降低心肺并发症发生率，并取得与开放手术相近的远期生存率。 |
| 关键词: 食管癌 食管切除术 胸腔镜 腹腔镜 |
| DOI：10.3969/j.issn.1674-3806.2019.10.17 |
| 分类号:R 615 |
| 基金项目: |
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| Comparison of the clinical effects between minimally invasive surgery thoracolaparoscopic esophagectomy and open esophagectomy on treatment of esophageal carcinoma |
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ZHENG Xiao-dong, ZHANG Wei-min, HOU Jian-bin
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Department of Thoracic Surgery, Anyang Tumor Hospital, Henan 455000, China
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| Abstract: |
| ［Abstract］ Objective To explore the safety and long-term outcomes of thoracolaparoscopic esophagectomy and open esophagectomy in treatment of esophageal carcinoma. Methods A total of 544 patients with esophageal squamous cell carcinoma admitted to the Department of Thoracic Surgery of Anyang Tumor Hospital from March 2014 to June 2018 were studied among whom 122 cases were enrolled as thoracoscopic and laparoscopic esophagectomy(TLE) group receiving TLE and using propensity score matching analysis method, other 122 cases as one on one matching open group(OE group) receiving open esophagectomy(OE). McKeown procedure was used in both surgical procedures. The perioperative related indexes were collected and the survivals followed up for 1～3 years. Results After matching the propensity score, TLE group had less intraoperative bleeding, shorter postoperative hospital stay, lower incidence rates of cardiopulmonary complications and total complications, and more lymph node dissection than OE group, all of which were statistically significant（P<0.05）. There were no statistically significant differences in the operation time, postoperative pleural fluid volume anastomotic fistula, chylothorax, and 30-day hospital mortality between the two groups（P>0.05）. The 1-year, 2-year and 3-year survival rates in TLE group were 95.1%, 74.6% and 57.4% respectively, while those in OE group were 94.3%, 70.5% and 47.5% respectively. There was no significant difference in 3-year cumulative survival rate between the two groups(P=0.095). Conclusion Thoracolaparoscopy is safe and reliable for esophagectomy. Compared with open surgery, it can significantly reduce the incidence of cardiopulmonary complications and achieve a long-term survival rate similar to that of open surgery. |
| Key words: Esophageal carcinoma Esophagectomy Thoracoscopy Laparoscopy |
