不同手术方式治疗食管癌的疗效分析

目的 探讨腔镜食管癌根治术与传统开放式食管癌根治术治疗食管癌的效果、安全性及生存质量差异.方法 选取2010年1月至2013年12月于该院实施手术治疗的185例食管癌患者进行回顾性分析,其中90例患者采用腔镜食管癌根治术(微创组),95例患者采用传统开放式食管癌根治术(传统组),对比两组围术期指标、术后生存率、并发症及生存质量.结果 两组患者的手术时间、清扫淋巴结数目比较,差异无统计学意义(P＞0.05);微创组患者的手术出血量、术后使用呼吸机患者百分比、术后住院时间和疼痛评分均低于传统组,术后肺功能高于传统组,差异均有统计学意义(P＜0.05).微创组患者的手术并发症总发生率(13.33％)明显低于传统组的25.26％(P＜0.05).术后3个月,微创组患者的躯体功能、角色功能、情感状态、认知功能和社会功能评分均高于传统组,疲劳状态、恶心及呕吐症状、疼痛情况、失眠、呼吸困难、便秘、腹泻和食欲下降评分均低于传统组,差异均有统计学意义(P＜0.05).术后1、2、3年,微创组的生存率分别为88.89％、73.33％、63.33％,传统组分别为80.00％、65.26％、55.79％,差异均无统计学意义(P＞0.05).结论 腔镜食管癌根治术治疗食管癌效果可靠,同时具有创伤小、恢复快、并发症少、术后生存质量高的优势.

Comparison analysis of efficacy of different surgical approaches for esophageal carcinoma

Objective To explore the difference in curative effect,safety of operation and quality of life between patients with esophageal carcinoma treated by the conventional open surgical approach and those treated by laparoscopic radical resection.Methods A total of 185 patients underwent esophageal cancer surgery in our hospital from January 2010 to December 2013 were retrospectively analysed,including 90 cases accepted laparoscopic radical resection (the minimally invasive group) and 95 patients accepted conventional open radical resection (the traditional group).The perioperative indexes,postoperative survival rate,complications and quality of life between the two groups were recorded and compared.Results No statistically significant difference was found in the operation time and number of lymph node dissected in patients between the two groups (P＞0.05).Compared with the traditional group,the amount of surgical bleeding,percentage of patients using postoperative ventilator,length of postoperative hospital stay and pain score in the minimally invasive group were significantly lower,while the postoperative lung function was better,there were statistically significant differences (P＜0.05).The postoperative complication rate in the minimally invasive group (13.33％) was lower than that in the traditional group (25.26％),there was statistically significant difference (P＜0.05).Three months after operation,the scores of dimensions,including physical function,role function,emotional state,cognitive function and social function,in the minimally invasive group were higher than those in the traditional group (P＜0.05);the scores of dimensions,including fatigue state,nausea and vomiting symptoms,pain,insomnia,difficulty breathing,constipation,diarrhea and loss of appetite,in the minimally invasive group were lower than those in the traditional group (P＜0.05).The 1-year,2-year and 3-year survival rates after operation in the minimally invasive group were 88.89％,73.33％ and 63.33％ respectively,which in the traditional group were 80.00％,65.26 ％ and 55.79 ％ respectively,there was no statistically significant difference between the two groups (P＞0.05).Conclusion The effect of laparoscopic radical resection of esophageal cancer is reliable,which has advantages of less operative trauma,quicker recovery,fewer complications,high quality of life after operation.