胸腹腔镜联合Ivor-Lewis手术与开放Ivor-Lewis手术治疗食管胸中、下段鳞癌的临床对比研究

发布时间：2018-03-02 14:26

本文选题：食管癌　切入点：腹腔镜　出处：《广西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨胸腹腔镜联合Ivor-Lewis食管癌根治术(Minimally Invasive Ivor-Lewis Esophagectomy,MIILE)治疗胸中、下段食管鳞癌的安全性、可行性和近期疗效。方法:回顾性分析2013年6月至2016年10月四川省肿瘤医院胸外科一个病区经上腹-右胸路径食管癌根治术的147例患者的临床资料,其中MIILE术式65例,开放Ivor-Lewis食管癌根治术(Open Ivor-Lewis Esophagectomy,ILE)82例,对比两组患者的围手术期指标、术后并发症发生率、术后疼痛评分以及术后生存率。结果:两组患者术前一般情况、肿瘤分期、术前合并症、术中出血量、平均淋巴结清扫数、术后拔管时间、进食时间、吻合口瘘、生存率比较无统计学差异。MIILE组手术时间较长(289.6±32.3min vs.260.8±26.3 min,P0.001),住院总费用较高(88030.9±8578.3元vs.80852.4±6014.3元,P0.001),术后住院时间较短(11.5±3.6d vs.13.0±4.5d,P=0.005),喉返神经损伤/麻痹发生率较低(4.6%vs.14.6%,P=0.046),肺部感染发生率较低(12.3%vs.25.6%,P=0.044),术后24h、48h、72h、1月疼痛评分较低(3.1±0.8 vs.4.2±0.9,3.9±0.9 vs.4.7±1.0,3.4±0.8 vs.4.6±0.9,2.7±0.7 vs.3.5±1.2,P0.001)。结论:MIILE术式具有安全性和可行性。MIILE术式手术时间较长,住院费用较高,但术后住院时间短,疼痛较轻,喉返神经损伤/麻痹和肺部感染发生率较低。因此,对分期在IIIA期以前,无颈部淋巴结转移的胸中、下段食管鳞癌患者,可首先考虑MIILE术式。
[Abstract]:Objective: to investigate the safety of thoracoscopic laparoscopy combined with radical resection of esophageal carcinoma with Ivor-Lewis in the treatment of middle and lower esophageal squamous cell carcinoma. Methods: from June 2013 to October 2016, the clinical data of 147 patients undergoing radical resection of esophageal carcinoma via epigastric and right thoracic pathway in a thoracic surgery area of Sichuan Cancer Hospital were analyzed retrospectively, including 65 cases of MIILE operation. There were 82 patients with open Ivor-Lewis esophageal carcinoma undergoing open Ivor-Lewis esophagectomy. The perioperative index, postoperative complication rate, postoperative pain score and postoperative survival rate were compared between the two groups. Results: the preoperative general condition, tumor stage, preoperative complications and complications were compared between the two groups. Intraoperative bleeding, mean lymph node dissection, extubation time, feeding time, anastomotic leakage, The survival rate of MIILE group was longer than that of 289.6 卤32.3min vs.260.8 卤26.3 min P0.001M, the total cost of hospitalization was 88030.9 卤8578.3 vs.80852.4 卤6014.3 vs.80852.4 卤6014.3 yuan P0.001L, the postoperative hospitalization time was shorter 11.5 卤3.6d 卤4.5dP0.005D, the incidence of recurrent laryngeal nerve injury / paralysis was lower than 4.6vs.14.6Vs.14.6P0.046m, the incidence of pulmonary infection was lower than 12.3vs.25.6vs.25.6Vs.25.60.44. The pain score in January was 3.1 卤0.8 vs.4.2 卤0.9 vs.4.7 卤0.9 vs.4.7 卤0.9 vs.4.6 卤0.9 vs.4.6 卤0.9 vs.4.6 卤0.9 vs.4.6 卤0.7 vs.3.5 卤1.2 P0.0010.Conclusion it is safe and feasible. The cost of hospitalization was higher, but the postoperative hospitalization time was short, the pain was mild, the incidence of recurrent laryngeal nerve injury / paralysis and pulmonary infection was lower. The MIILE procedure can be considered first.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.1

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