三切口食管癌切除术与胸腔镜辅助手术的疗效比较

目的:对比分析三切口食管癌切除术与胸腔镜辅助食管癌切除术的临床疗效。方法:将食管癌患者分为两组,胸腔镜辅助组11例,行胸腔镜游离食管+开腹游离胃+颈部吻合术;常规组23例,行常规三切口食管癌切除术。对比分析两组住院时间、住院费用、手术时间、出血量、淋巴结清扫数量、患者疼痛情况、胸管引流量、术后并发症。结果:两组均无围手术期死亡。住院时间、出血量、淋巴结清扫数量两组差异无统计学意义(P>0.05),胸腔镜辅助组住院花费高,手术时间长,并发症发生率高,但胸管引流量低,与常规组相比差异有统计学意义(P<0.05),且常规组疼痛评分较高。结论:食管癌的腔镜手术需一定的学习曲线,开展初期微创优势可能不明显,应严格把握手术适应证,尽量选择体形较瘦、手术难度相对较小的患者。

Comparison of clinical efficacy between three-incision esophagectomy and thoracoscopic-assisted esophagectomy for esophageal cancer

Objective： To comparatively analyze the clinical efficacy of three-incision esophagectomy and thoracoscopic-assisted esophagectomy for esophageal cancer. Methods： The patients suffering from esophageal cancer were divided into two groups. The surgical procedure in thoracoscopic-assisted group（ n = 11） was freeing esophagus by thoracoscopy,freeing stomach in open surgery and cervical anastomosis. 23 cases in conventional group underwent three-incision esophagectomy. Hospital stay,hospitalization cost,operation time,blood loss,number of lymph node dissection,pain,chest tube drainage and postoperative complications in two groups were observed and statistically analyzed. Results： There was no perioperative mortality in two groups. There was no significant difference between two groups in hospital stay,intraoperative blood loss and number of lymph node dissection（ P〉 0. 05）. Thoracoscopic-assisted group was characterized by higher cost,longer operation time,higher incidence of complications and fewer chest drainage compared with conventional group（ P 〈0. 05）,and the pain scores were relatively higher in conventional group. Conclusions： A certain learning curve is required in studying esophageal endoscopic surgery,and minimally invasive advantages may not be apparent in early period. Surgeons should strictly grasp the surgical indication and choose lean patients,so that the operation could be easily completed.