VATS食管癌切除胸部淋巴结清扫术的效果及对术后生存质量的影响

目的探讨在食管癌胸部淋巴结清扫术中使用电视辅助胸腔镜(VATS)手术的效果及术后生存质量的影响。 方法回顾性分析2014年3月至2016年5月期间行食管癌根治术75例食管癌患者。按照手术方式不同分为行VATS术38例(VATS组)和行传统开胸手术37例(传统组)，采用软件SPSS18.0分析数据，术中术后各项指标和生命质量评价以( ±s)表示，采用独立t检验；术后并发症及1年生存率采用χ²检验，以P<0.05为差异有统计学意义。 结果VATS组从淋巴结清扫数、术中出血量、住院时间、术后引流量、自主下床活动时间方面比较，均优于传统组(P<0.01)。VATS组肺部感染、切口感染(胸腹部)、吻合口漏等术后并发症明显低于传统组(P<0.01)。两组患者1年期生存率VATS组与传统组分别为(73.68%比67.57%)差异无统计学意义(P>0.05)。生存质量评分在术后第1周、12周时两组吞咽困难症状得分均明显降低，VATS组在疲劳、体力功能、术后疼痛、综合生命质量等生命质量维度得分显著优于传统组(P<0.05)。 结论食管癌胸部淋巴结清扫使用VATS手术时有着治疗效果好，术后恢复快、术后并发症少，能显著改善患者术后生存质量，临床中值得推广。

Effect of VATS on thoracic lymph node dissection for esophageal cancer and its effect on postoperative quality of life

ObjectiveTo observe the effect of VATS on thoracic lymph node dissection for esophageal cancer and its effect on postoperative quality of life. Methods75 patients with esophageal cancer treated in our hospital from March 2014 to May 2016 were selected into data. According to the operation mode, 38 cases were divided into video-assisted thoracoscopic surgery (VATS group) and 37 cases underwent traditional thoracotomy (traditional group). The data was analyzed by SPSS18.0.Intraoperative and postoperative indicators and quality of life were assessed by independent t test. The postoperative complications and the one-year survival rate were examined by χ² test. The results were statistically significant with the difference of P<0.05. ResultsThe VATS group was superior to the traditional group (P<0.01) in terms of lymph node dissection, intraoperative blood loss, hospitalization time, postoperative drainage, and time of spontaneous ambulation. In the VATS group, pulmonary infection, incision infection (thoracic abdomen), removal of chylothorax, and revision of the British abstract] postoperative complications such as anastomotic leakage were significantly lower than the conventional group (P<0.01). The 1-year survival rate of the two groups was not statistically significant (P>0.05) between the VATS group and the traditional group (73.68% vs. 67.57%). The scores of dysphagia in the two groups were significantly lower in the quality of life scores at the first week and the 12th week after surgery. The VATS group scored significantly better than the traditional group in terms of fatigue, physical function, postoperative pain, and comprehensive quality of life. P<0.05). ConclusionThe treatment of thoracic lymph node dissection of esophageal cancer with VAST assisted surgery has good therapeutic effect, rapid recovery and less postoperative complications. It can significantly improve the quality of postoperative survival of the patients. It is worth popularizing in clinical practice.