易和强 陈光明 刘浩

[摘要]目的 通過胸腹腔联合食管癌根治术与传统开胸手术术中、术后相关数据比较，总结相关临床经验。方法 回顾性分析2017年5月～2018年5月我院收治的69例食管癌患者的临床资料，按照不同手术方式将其分为微创组（28例）与开放组（41例）。微创组患者行胸腹腔镜联合食管癌根治术治疗，开放组患者行传统开胸手术治疗。比较两组患者的术中出血量、手术时间、淋巴结清扫数目、术后胸腔引流量、胸腔引流管拔除时间、术后住院时间及术后肺部并发症总发生率。结果 微创组患者的手术时间长于开放组，术中出血量及术后引流量均少于开放组，淋巴结清扫数目多于开放组，胸腔引流管拔除时间短于开放组，差异有统计学意义（P<0.05）;两组患者的术后住院时间比较，差异无统计学意义（P>0.05）。微创组患者的术后肺部并发症总发生率为31.7%，明显低于开放组的7.1%，差异有统计学意义（P<0.05）。结论 胸腹腔镜联合食管癌根治术的效果明显优于传统开胸手术，值得广泛推广。但对于在开展微创食管癌根治手术初期的术者来说经验尚不丰富。

[关键词]胸腹腔镜;开胸手术;食管癌根治

[中图分类号] R735.1          [文献标识码] A          [文章编号] 1674-4721（2019）6（b）-0057-04

[Abstract] Objective To summarize the relevant clinical experience by comparing the intraoperative and postoperative data of thoracic laparoscopy combined with radical resection of esophageal cancer surgery and traditional thoracotomy. Methods The clinical data of 69 patients with esophageal cancer admitted to our hospital from May 2017 to May 2018 were retrospectively analyzed. They were divided into minimally invasive group （28 cases） and open group （41 cases） according to different surgical methods. Patients in the minimally invasive group underwent thoracic laparoscopy combined with radical resection of esophageal cancer surgery， and patients in the open group underwent traditional thoracotomy. The intraoperative blood loss， operation time， number of lymph node dissection， volume of postoperative thoracic drainage， removal time of thoracic drainage tube， postoperative hospitalization time and total incidence rate of postoperative pulmonary complications were compared between the two groups. Results The operation time in the minimally invasive group was longer than that in the open group， the intraoperative blood loss and postoperative thoracic drainage volume were less than those in the open group， the number of lymph node dissection was more than that in the open group， and the removal time of thoracic drainage tube was shorter than that in the open group， with statistically significant differences （P<0.05）. There was no significant difference in postoperative hospitalization time between the two groups （P>0.05）. The total incidence rate of postoperative pulmonary complications in the minimally invasive group was 31.7%， which was significantly lower than that in the open group （7.1%）， and the difference was statistically significant （P<0.05）. Conclusion The effect of thoracic laparoscopy combined with radical resection of esophageal cancer surgery is significantly better than that of traditional thoracotomy， which is worthy of widespread promotion. However， the experience of the early stage of radical surgery for minimally invasive esophageal cancer is not rich to operators.

[Key words] Thoracic laparoscopy; Thoracotomy; Radical resection of esophageal cancer

食管癌是胸外科常见的恶性肿瘤之一，其发病率及死亡率均较高，且好发老年男性[1]，就目前治疗而言，仍以手术为主，放化疗为辅的治疗模式。手术方式分为传统开胸食管癌和胸腹腔联合食管癌根治，前者手术创伤较大，术后并发症较多、较严重[2]，死亡率较高;后者目前已成为主要的手术方式，其优点在于安全、创伤较小。经过充分的准备后，我科积极致力于胸腹腔镜联合食管癌根治术的开展，目前为止已完成28例手术，现在将治疗情况作一回顾并进行经验总结。……