胸腹腔镜与开胸手术治疗早期食管癌的临床疗效对比

目的 评价胸腹腔镜下早期食管癌根治术的临床应用价值。方法 选择我院2010年6月至2011年12月接受胸腹腔镜(n=56)和传统开胸(n=53)行食管癌根治术的病例资料,比较两组患者的术中情况、术后并发症、复发或转移率、病死率及随访情况等差别。结果 腔镜组的手术时间长于开胸组,但失血量、住院时间、转ICU病例数、胸液引流时间、胸液引流量等方面优于开胸组,差异有统计学意义(P<0.05)。两组的淋巴结清扫数量、阳性淋巴结率差异无统计学意义。腔镜组术后总并发症发生率8.9%,少于开胸组的11.3%,但差异无统计学意义。两组随访3～21个月,腔镜组复发或转移率为5.7%,生存率98.1%；开胸组复发或转移率8.3%,生存率为97.9%；两组在复发或转移率及生存率等方面差异无统计学意义。结论 应用胸腔镜联合腹腔镜行食管癌根治术创伤小、并发症少、恢复快,具有与开胸手术相当的近期疗效,是一种安全、可行、临床效果好的微创术式。

Thoracoscopic and laparoscopic esophagectomy versus open procedure for early stage esophageal carcinoma: comparison of clinical outcomes

Objective To evaluate the clinical value of thoracoscopy combined with laparoscopy for the treatment of early stage esophageal carcinoma.Methods From June 2010 to December 2011,56 patients with esophageal carcinoma receiving thoracoscopic and laparoscopic esophagectomy(TLE)in our hospital and 53 receiving conventional open esophagectomy(OE) were included in the present study.The operative procedures,postoperative complications,recurrence or metastasis rates,mortality and follow-up outcomes were compared between the two groups.Results Compared with the OE group,TLE group had significantly less blood loss,shorter hospital stay,fewer ICU cases,shorter chest tube duration,less chest drainage amount and longer operation time(P<0.05).The number of harvested lymph nodes and positive lymph node rate were not significantly different between the two groups.The incidence rate of postoperative complication was 8.9% in TLE group and 11.3% in OE group(P>0.05).The two groups were followed up for 3 to 21 months.TLE group had a recurrence or metastasis rate of 5.7%,similar to that in the OE group(8.3%,P>0.05).The total survival rate of TLE group was 98.1%,which was similar to that in the OE group(97.9%,P>0.05).Conclusion Thoracoscopic and laparoscopic esophagectomy is a safe,feasible,effective and minimally invasive method for treatment of esophageal cancer;it has less complications and quick recovery and has a similar short-term outcome to conventional open esophagectomy.