胸腹腔镜联合根治术治疗老年食管癌患者的疗效及安全性分析

目的:探讨胸腹腔镜联合根治术治疗老年食管癌患者的临床疗效。方法:选取本院收治的老年食管癌患者64例，按手术方式将其分为开放组（n=29）及胸腹腔镜组（n=35），分别行开放式食管癌根治术及胸腹腔镜联合食管癌根治术治疗。统计并比较两组患者手术情况，检测并比较术前及术后1周两组患者细胞免疫功能变化，术后定期随访1年，比较两组患者生存情况、复发情况、并发症发生情况及生活质量，并分析两组患者并发症情况相关因素。结果:与开放组比较，胸腹腔镜组患者手术时间、术后拔管时间、住院时间均显著缩短（P＜0.01），手术切口显著减小（P＜0.01），术中失血量、术后胸腔引流量均显著降低（P＜0.01）。与术前比较，术后1周两组全血CD4+ T淋巴细胞比例、CD4+/CD8+均显著降低（P＜0.05或P＜0.01），且胸腹腔镜组显著高于开放组（P＜0.01）；术后1周胸腹腔镜组CD8+ T淋巴细胞比例较术前及开放组均显著降低（P＜0.05）。与开放组比较，胸腹腔镜组患者术后吻合口瘘发生率及总并发症发生率均显著降低（P＜0.05或P＜0.01）。随访期间胸腹腔镜组患者SF-36评分显著升高（P＜0.01），而复发率显著降低（P＜0.05）；两组1年生存率比较无显著性差异（P＞0.05）。结论:胸腹腔镜联合根治术可有效减轻老年食管癌患者手术创伤，保护机体免疫功能，还可降低患者术后并发症，改善其生活质量，安全性良好。

Efficacy and safety analysis of thoracic laparoscopy combined with radical surgery in the treatment of elderly esophageal cancer patients

Objective:To explore the efficacy and safety of thoracic laparoscopy combined with radical surgery in the treatment of elderly esophageal cancer patients.Methods:64 cases elderly esophageal cancer patients in our hospital were selected and divided into open group (n=29) and thoracic and laparoscopic group (n=35) by surgical approach,and treated with open esophageal cancer radical surgery and thoracic laparoscopy combined with radical surgery respectively.The surgical situation of 2 groups was compared.The changes of cellular immunity function in 2 groups before operation and at 1 week after operation were detected and compared.The survival,recurrence,complications and life quality during following-up were compared.Results:Compared with open group,the operation time,extubation time,hospitalization time in thoracic and laparoscopic group shortened significantly (P＜0.01).The operative incision was significantly reduced (P＜0.01).The intraoperative blood loss and postoperative chest drainage were significantly decreased (P＜0.01).Compared with pre-operation,the proportion of whole blood CD4+ T lymphocytes,CD4+/CD8+ decreased significantly (P＜0.05 or P＜0.01),and thoracic and laparoscopic group was higher than open group (P＜0.01).The proportion of whole blood CD8+ T lymphocytes at 1 week after operation in thoracic and laparoscopic group was decreased compared with pre-operation and open group (P＜0.05).Compared with open group,the anastomotic fistula occurrence rate and total complication occurrence rate in thoracic and laparoscopic group were decreased significantly (P＜0.05 or P＜0.01).The SF-36 score of thoracic and laparoscopic group increased significantly during following-up (P＜0.01),while the recurrence rate decreased significantly during following-up (P＜0.05).The 1-year survival rate in two groups had no significant difference (P＞0.05).Conclusion:Thoracic laparoscopy combined with radical surgery can reduce the surgical trauma of elderly esophageal cancer patients effectively,protect the immunity function,cut down postoperative complications,improve patinets' life quality,and the safety is fine.