CAJ | 학술논문

目的比较胸腔镜与腹腔镜联合手术与开放手术治疗食管癌的疗效差异.方法对2011年3月至2014年3月江苏省泰兴市人民医院胸外科62例胸腔镜与腹腔镜联合手术患者(腔镜组)和62例开放手术的患者(开放组)的临床资料进行分析.两组均为男性45例,女性17例;平均年龄分别为(62±9)岁和(62 ±8)岁.两组患者在年龄、肿瘤部位、病理类型及肿瘤分期等方面差异均无统计学意义.收集围手术期相关指标,同时随访3年生存情况.t检验和x2检验比较两组一般资料,Kaplan-Meier法绘制生存曲线,采用Log-rank检验进行生存率比较.结果腔镜组的术中出血量[(231 ±40) ml比(302±37) ml,t=4.63,P=0.000]、术后胸腔引流量[(490±41) ml比(1 090±43) ml,t=-79.59,P=0.000]和术后住院时间[(16±4)d比(17±4)d,t=-2.61,P=0.010]低于开放组;手术时间[(272±39) min比(242±45) min,t =3.97,P=0.000]、淋巴结清扫数目[(30±5)个比(28±4)个,t=2.39,P=0.018]和胸部淋巴结清扫数目[(15±4)个比(14 ±3)个,t=2.59,P=0.011]高于开放组.两组分别有19例和31例发生术后并发症,差异有统计学意义(x2=4.83,P=0.028).腔镜组3年累积生存率为73.2％,开放组为71.4％,差异无统计学意义(x2=0.170,P＞0.05).结论胸腹腔镜联合治疗食管癌在出血量、住院时间和并发症等方面优于开放手术,但3年累积生存率无统计学差异.
목적 비교흉강경여복강경연합수술여개방수술치료식관암적료효차이.방법 대2011년3월지2014년3월강소성태흥시인민의원흉외과62례흉강경여복강경연합수술환자(강경조)화62례개방수술적환자(개방조)적림상자료진행분석.량조균위남성45례,녀성17례;평균년령분별위(62±9)세화(62 ±8)세.량조환자재년령、종류부위、병리류형급종류분기등방면차이균무통계학의의.수집위수술기상관지표,동시수방3년생존정황.t검험화x2검험비교량조일반자료,Kaplan-Meier법회제생존곡선,채용Log-rank검험진행생존솔비교.결과 강경조적술중출혈량[(231 ±40) ml비(302±37) ml,t=4.63,P=0.000]、술후흉강인류량[(490±41) ml비(1 090±43) ml,t=-79.59,P=0.000]화술후주원시간[(16±4)d비(17±4)d,t=-2.61,P=0.010]저우개방조;수술시간[(272±39) min비(242±45) min,t =3.97,P=0.000]、림파결청소수목[(30±5)개비(28±4)개,t=2.39,P=0.018]화흉부림파결청소수목[(15±4)개비(14 ±3)개,t=2.59,P=0.011]고우개방조.량조분별유19례화31례발생술후병발증,차이유통계학의의(x2=4.83,P=0.028).강경조3년루적생존솔위73.2％,개방조위71.4％,차이무통계학의의(x2=0.170,P＞0.05).결론 흉복강경연합치료식관암재출혈량、주원시간화병발증등방면우우개방수술,단3년루적생존솔무통계학차이.
Objective To study the efficacy and safety of thoracoscopic and laparoscopic esophagectomy for esophageal carcinoma.Methods Based on hospitalization data from March 2011 to March 2014,62 cases of esophageal carcinoma treated with thoracoscopic and laparoscopic esophagectomy (minimally invasive group,with 45 male patients) and other 62 cases treated with open esophagectomy (open esophagectomy group,with 45 male patients) were analyzed in a retrospective cohort.The mean age of two groups were (62 ± 9) years and (62 ± 8) years,respectively.Quantitative data were analyzed using t-test,whereas qualitative variables were tested with x2 test.There were no significant difference in age,tumor location,pathological type,tumor staging between two groups (P ＞ 0.05).Perioperative data and three-year clinic outcome were collected.The three-year survival curve were calculated with the KaplanMeier method and compared by the log-rank test between the two groups.Results Compared with open esophagectomy group,minimally invasive group has less amount of bleeding during operations ((231 ± 40) ml vs.(302 ± 37) ml,t =4.63,P =0.000),pleural drainage after operations ((490 ± 41) ml vs.(1 090 ± 43) ml,t =-79.59,P =0.000),and postoperative hospital stay ((16 ± 4) days vs.(17 ± 4) days,t =-2.61,P =0.010).Meanwhile,minimally invasive group has more operation time ((272 ± 39) minutes vs.(242 ± 45) minutes,t =3.97,P =0.000) and total and thoracic cavity retrieved lymph nodes (30±5vs.28±4,t=2.39,P=0.018;15 ±4 vs.14±3,t=2.59,P=0.011).Nineteen and 31 patients had postoperative complications and statistical significance difference was found between two groups (x2 =4.83,P =0.028).The three-year survival rate was 73.2％ in minimally invasive group and 71.4％ in open esophagectomy group.There was no significance difference between two groups (x2 =0.170,P ＞ 0.05).Conclttsion Thoracoscopic and laparoscopic esophagectomy had the advantages of amount of bleeding,postoperative hospital stay and complications,and had the same three-year survival rate with open esophagectomy.