CAJ | 학술논문

目的：评价微创食管癌切除术在T 1b期食管癌外科治疗中相对传统开放手术的优势。方法回顾性分析上海胸科医院2012年1月1日至2014年12月31日连续性收治的168例T1b期食管癌患者的临床资料。根据患者接受手术方式的不同分为微创组（胸腔镜行食管切除，腹腔镜腹腔操作或开放腹腔操作游离胃，行颈部食管胃吻合）69例和开放组（行传统开放手术）99例，比较两组患者的术中及术后情况，采用Logistic回归分析影响术后住院时间的因素。结果微创组患者无术中中转开胸病例。与开放组比较，微创组术中清扫淋巴结数目（中位数12枚／例比9枚／例， P＝0．004）较多；术后肺炎[5．8％（4／69）比21．2％（21／99），P＝0．011]和胸腔积液[8．7％（6／69）比23．2％（23／99），P＝0．027]发生率较低；术后住院时间（中位数11 d比14 d，P＝0．041）较短；但微创组有1例患者镜下切缘为阳性。微创组术后30 d内无死亡病例；而开放组1例患者因吻合口瘘胸腔感染致呼吸衰竭死亡。 Logistic回归分析显示，喉返神经麻痹、吻合口瘘及手术治疗方式是影响患者住院时间的主要因素（均P＜0．05）；微创手术是患者住院时间缩短的保护因素（P＝0．013）。结论建议T1b期食管癌选择胸腹腔镜食管癌切除术。
목적：평개미창식관암절제술재T 1b기식관암외과치료중상대전통개방수술적우세。방법회고성분석상해흉과의원2012년1월1일지2014년12월31일련속성수치적168례T1b기식관암환자적림상자료。근거환자접수수술방식적불동분위미창조（흉강경행식관절제，복강경복강조작혹개방복강조작유리위，행경부식관위문합）69례화개방조（행전통개방수술）99례，비교량조환자적술중급술후정황，채용Logistic회귀분석영향술후주원시간적인소。결과미창조환자무술중중전개흉병례。여개방조비교，미창조술중청소림파결수목（중위수12매／례비9매／례， P＝0．004）교다；술후폐염[5．8％（4／69）비21．2％（21／99），P＝0．011]화흉강적액[8．7％（6／69）비23．2％（23／99），P＝0．027]발생솔교저；술후주원시간（중위수11 d비14 d，P＝0．041）교단；단미창조유1례환자경하절연위양성。미창조술후30 d내무사망병례；이개방조1례환자인문합구루흉강감염치호흡쇠갈사망。 Logistic회귀분석현시，후반신경마비、문합구루급수술치료방식시영향환자주원시간적주요인소（균P＜0．05）；미창수술시환자주원시간축단적보호인소（P＝0．013）。결론건의T1b기식관암선택흉복강경식관암절제술。
Objectives To evaluate the efficacy and advantage of minimally invasive esophagectomy for surgical treatment of submucosal esophageal cancer compared to conventional open procedure. Methods Clinical data of consecutive 168 patients with stage T1b submucosal esophageal cancer undergoing minimally invasive esophagectomy (MIE, esophagectomy by thoracoscope, stomach freeing by laparoscope or open abdomen, cervical esophagogastric anastomosis) or conventional open esophagectomy (OE) at the Shanghai Chest Hospital between January 1, 2012 and December 31, 2014 were reviewed retrospectively. Intraoperative and postoperative information was compared between the two groups. Results Both groups were equally stratified by sex, body mass index and age. No patient of MIE group was transferred to open operation. As compared to the OE group , the MIE group had significantly more harvest lymph nodes (median 12 vs. median 9, P=0.004), lower rate of postoperative pneumonia [5.8%(4/69) vs. 21.2%(21/99), P=0.011] and pleural effusion [8.7%(6/69) vs. 23.2%(23/99), P=0.027], and shorter hospital stay (median 11 d vs. median 14 d, P=0.041), but positive margin was found in 1 case. There were no significant differences of respiratory failure , pneumothorax, atrial arrhythmia, pulmonary embolism, recurrent nerve palsy, anastomotic leak, reoperations and 30-day mortality between the two groups. Multivariate logistic analysis revealed recurrent nerve palsy , anastomotic leak and surgical approach were found to be the main factors of hospital stay within postoperative 12 days, while leakage when the in-hospital time more than 12 days. Kaplan-Meier analysis showed that the surgical approach was the independent factor of hospital stay , MIE could shorten the hospital stay (P=0.013). Conclusion MIE should be considered as the standard approach in the treatment of T1b submucosal esophageal cancer.