全胸腔镜联合非气腹腹腔镜辅助食管癌根治术与常规手术的对比研究

目的探讨全胸腔镜联合非气腹腹腔镜辅助食管癌根治术较常规开胸手术的优势。方法 2006年11月～2008年5月施行电视胸腔镜联合非气腹腹腔镜辅助食管癌根治术111例(研究组),同期施行常规开胸手术110例(对照组),比较2组患者临床疗效。结果研究组手术时间(272.3±57.9)min显著长于对照组(218.7±91.0)min(t=5.229,P=0.000);研究组术中出血量(219.7±194.4)ml显著少于对照组(590.0±324.4)ml(t=-10.304,P=0.000);研究组术后住院时间(9.6±1.7)d显著短于对照组(11.4±2.3)d(t=6.620,P=0.000)。研究组术后切口液化发生率为0,显著低于对照组6.3%(7/111)(P=0.007)。对照组清扫淋巴结(39.2±12.5)枚,显著少于研究组(44.3±21.0)枚(t=-2.191,P=0.029)。2组病人术后生存率无统计学差异(log-rank检验,χ2=0.348,P=0.555)。结论 全胸腔镜联合非气腹腹腔镜辅助食管癌根治术出血少、恢复快、并发症少、淋巴结清扫更彻底,尽管手术时间较常规手术长,但远期疗效与常规手术相同。

Comparison between Video-assisted Thoracic Surgery(VATS) Combined with Gasless Laparoscopy and Traditional Open Transthoracic Esophagectomy for Esophageal Cancer

Objective To evaluate the advantages of video-assisted thoracic surgery(VATS) combined with gasless laparoscopy compared to traditional open transthoracic esophagectomy in patients with esophageal cancer. Methods From November 2006 to May 2008,we carried out this study on 221 patients with esophageal cancer in our hospital.The patients were divided into two groups based on the hospital admission time:111 patients underwent VATS combined with gasless laparoscopic esophagectomy(study group),and the other 110 patients received traditional open esophagectomy(control group).The efficacy of the two groups were compared afterwards.Results Compared to the control group,the study group showed significantly longer operation time (272.3±57.9) min vs.(218.7±91.0) min,t=5.229,P=0.000],less intraoperative blood loss (219.7±194.4) ml vs.(590.0±324.4) ml,t=-10.304,P=0.000],shorter postoperative hospital stay (9.6±1.7) d vs.(11.4±2.3) d,t=6.620,P=0.000],lower rate of incision fat liquefaction 0 vs.6.3%(7/111),P=0.007],and more removed lymph nodes 44.3±21.0 vs.39.2±12.5,t=-2.191,P=0.029].No significant difference was observed in the survival rate between the two groups(log-rank test,χ2=0.348,P=0.555). Conclusions Compared to traditional open surgery,VATS combined with gasless laparoscopic esophagectomy shows less intraoperative blood loss,quicker recovery,less complications,and better clearance of lymph nodes with comparable efficacy,but longer operation time and the same long-term efficacy.