CAJ | 학술논문

目的探讨胸、腹腔镜联合手术治疗70岁及以上老年食管癌患者的可行性.方法 2010年1月至2014年6月,施行胸腔镜联合腹腔镜食管癌切除+胸、腹二野淋巴结清扫切除526例,分成高龄组(≥70岁,132例)和非高龄组(＜70岁,394例),对比两组术前危险因素(高血压、糖尿病、心功能不全、肺功能不全、脑梗塞)、手术创伤(喉返神经损伤、手术时间、术中出血量)及淋巴结清扫组数、术后并发症(肺部并发症,心脏并发症、乳糜胸、吻合口瘘、切口愈合不良、胸胃无力)的发生率,术后恢复(术后住院时间)和术后早期死亡比例;并进行统计学分析.结果高龄组患者术前高血压、脑梗塞、心功能不全及肺功能不全的患病率显著高于非高龄组(P＜0.05);糖尿病的患病率两组差异无统计学意义.两组在手术时间、喉返神经损伤、术中出血量及淋巴结清扫组数上差异均无统计学意义(P＞0.05).高龄组在术后肺部及心脏并发症发病率显著高于非高龄组(P＜0.05);而在乳糜胸、吻合口瘘及切口愈合不良、胸胃无力中两组差异无统计学意义(P＞0.05).两组手术并发症中肺部并发症发生率最高,均显著高于其他并发症.两组在术后住院天数中差异有统计学意义,高龄组明显高于非高龄组.术后早期死亡比例两组差异无统计学意义.结论高龄食管癌患者术后心脏及肺部并发症较高、术后需要更长的恢复时间;但胸腔镜联合腹腔镜食管癌切除术在治疗高龄患者是安全、可行.
목적 탐토흉、복강경연합수술치료70세급이상노년식관암환자적가행성.방법 2010년1월지2014년6월,시행흉강경연합복강경식관암절제+흉、복이야림파결청소절제526례,분성고령조(≥70세,132례)화비고령조(＜70세,394례),대비량조술전위험인소(고혈압、당뇨병、심공능불전、폐공능불전、뇌경새)、수술창상(후반신경손상、수술시간、술중출혈량)급림파결청소조수、술후병발증(폐부병발증,심장병발증、유미흉、문합구루、절구유합불량、흉위무력)적발생솔,술후회복(술후주원시간)화술후조기사망비례;병진행통계학분석.결과 고령조환자술전고혈압、뇌경새、심공능불전급폐공능불전적환병솔현저고우비고령조(P＜0.05);당뇨병적환병솔량조차이무통계학의의.량조재수술시간、후반신경손상、술중출혈량급림파결청소조수상차이균무통계학의의(P＞0.05).고령조재술후폐부급심장병발증발병솔현저고우비고령조(P＜0.05);이재유미흉、문합구루급절구유합불량、흉위무력중량조차이무통계학의의(P＞0.05).량조수술병발증중폐부병발증발생솔최고,균현저고우기타병발증.량조재술후주원천수중차이유통계학의의,고령조명현고우비고령조.술후조기사망비례량조차이무통계학의의.결론 고령식관암환자술후심장급폐부병발증교고、술후수요경장적회복시간;단흉강경연합복강경식관암절제술재치료고령환자시안전、가행.
Objective The incidence of complications after esophageal cancer surgery is relatively high.The purpose of this paper was to explore the feasibility of combined thoraco-laparoscopy surgical treatment for senile esophageal cancer(over 70 years old).Methods A total of 526 esophageal cancer cases were retrospectively analyzed in this study.The operative procedures was esophageal carcinoma resection surgery and thoracic and abdominal lymphadenectomy which were operated through video-assisted by thoracoscope and laparoscopic From January 2010 to June 2014 in the Union Hospital of Fujian Medical University,divided into aged groups(≥70 years old,n =132) and non-aged group(＜ 70 years old,n =394).Statistical analysis was carried on the rate of two groups of preoperative risk factors(hypertension,diabetes,cardiac insufficiency,pulmonary insufficiency,cerebral infarction),surgical trauma and the number of lymph node dissection (laryngeal recurrent nerve injury,operation time,intraoperative blood loss),postoperative complications(cardiac complications,chylothorax,pulmonary complications,anastomotic fistula,poor healing of the incision,intrathoracic stomach atony),postoperative recovery and early postoperative mortality.Results Preoperative risk factors:the prevalence of the aged group with hypertension,cerebral infarction,cardiac insufficiency,and pulmonary insufficiency was significantly higher than the non-aged group (P ＜ 0.05) but diabetes (P ＞ 0.05).Surgical trauma and the number of lymph node dissection:no significant difference (P ＞ 0.05).Postoperative complications:the aged group was higher in the incidence of pulmonary complications and cardiac complications than the other (P ＜ 0.05) ; but the chylothorax,anastomotic fistula and poor healing of incision,intrathoracic stomach atony in the two groups seemed no significant difference(P ＞ 0.05).Furthermore,pulmonary complications were highest in the all complications,significantly higher than the others in both groups.Postoperative recovery:significant difference existed in postoperative hospitalization days,the aged group was obviously longer than the non-age groups.Early postoperative mortality rates in the two groups had no significant difference.Conclusion The aged patiences had a higher prevalence in the preoperative risk factors and so was the cardiac complications as well as pulmonary complications among the postoperative complications.However the combined thoraco-laparoscopy in the surgical treatment of elderly patients with esophageal cancer is safe and feasible.