CAJ | 학술논문

目的探讨术前放化疗对微创食管切除术(MIE)手术质量及围术期的影响.方法符合入组条件的初治胸段局部晚期食管鳞癌63例,随机分成对照组与试验组,对照组33例行单纯MIE治疗,试验组30例行术前放化疗联合MIE治疗,遵循意向性处理原则,对其手术质量及围术期状况进行对比评价.结果对照组与试验组中转开胸率分别是6.1％与3.3％；R0切除率分别是97.0％与93.3％；两组间差异均无统计学意义(P＞0.05).试验组除胸部手术时间较对照组显著延长外(P=0.018),其余各项指标包括总手术时间、失血量、正常结构的暴露与保护、清扫淋巴结数目两组比较差异均无统计学意义(P＞0.05).试验组总体并发症发生率50.0％,较对照组(39.4％)略高,但差异无统计学意义(P＞0.05).结论术前放化疗虽略增加了MIE的手术难度,但对原发灶及淋巴结的根治性切除影响不大,围术期并发症增加不明显,因此术前放化疗后MIE安全可行.
목적 탐토술전방화료대미창식관절제술(MIE)수술질량급위술기적영향.방법 부합입조조건적초치흉단국부만기식관린암63례,수궤분성대조조여시험조,대조조33례행단순MIE치료,시험조30례행술전방화료연합MIE치료,준순의향성처리원칙,대기수술질량급위술기상황진행대비평개.결과 대조조여시험조중전개흉솔분별시6.1％여3.3％；R0절제솔분별시97.0％여93.3％；량조간차이균무통계학의의(P＞0.05).시험조제흉부수술시간교대조조현저연장외(P=0.018),기여각항지표포괄총수술시간、실혈량、정상결구적폭로여보호、청소림파결수목량조비교차이균무통계학의의(P＞0.05).시험조총체병발증발생솔50.0％,교대조조(39.4％)략고,단차이무통계학의의(P＞0.05).결론 술전방화료수략증가료MIE적수술난도,단대원발조급림파결적근치성절제영향불대,위술기병발증증가불명현,인차술전방화료후MIE안전가행.
Objective To explore the effects of preoperative chemoradiotherapy on minimally invasive esophagectomy (MIE),regarding tooperation quality and complications.Methods Sixty-three qualified patients with locally advanced staged (Ⅱb-Ⅲc) thoracic esophageal squamous cancer were recruited in this study and randomly assigned to control and test group.Control group included 30 patients who underwent MIE alone,while test group included 33 patients who underwent preoperative chemoradiotherapy followed by MIE.All the evaluation indicators,including operating time,blood loss,protection of normal structures,complications,length of ICU stay and postoperative stay,and lymph nodes harvest,were collected and compared between groups following the intention-to-treat principle.Results During operation,two patients (6.1％) were shifted to open thoracotomy in control group,comparing to one patient (3.3％) in test group.R0 resection rates of control and test group were 97.0％ and 93.3％,respectively.Neither of the statistical significances were achieved between groups (P ＞0.05).Except for thoracic operative time,which was spent significantly more in test group than in control group (P =0.018),the other indicators including total operating time,blood loss,protection of normal structures,and lymph nodes harvest were not found significantly different between groups (P ＞0.05).Postoperative complication rate was 50％ in test group and 39.4％ in control group,without significant difference either (P ＞ 0.05).Conclusion Although causing surgical difficulty on MIE,preoperative chemoradiotherapy has little effect on quality control of resection and perioperative complications.Preoperative chemoradiotherapy followed by MIE is a safe and feasible modality in treating locally advanced staged thoracic esophageal squamous cancer.