三野微创食管切除术与开放手术治疗食管癌临床疗效的对比研究

发布时间：2018-01-04 03:42

本文关键词：三野微创食管切除术与开放手术治疗食管癌临床疗效的对比研究　出处：《第四军医大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的食管切除术是治疗食管癌(esophageal cancer,EC)的重要手段,但手术复杂,手术创伤大,术后并发症多见,具有很高的死亡率。微创食管切除术(minimally invasive esophagectomy,MIE)是目前外科的发展方向,具有创伤小、恢复快等特点。本研究通过对三野微创食管切除术(three filed minimally invasive esophagectomy,TMIE)与开放性食管切除术(open esophagectomy,OE)治疗食管癌的对比,探讨TMIE在治疗食管癌中的临床疗效。方法1.对第四军医大学西京消化病医院及唐都医院胸外科2010年1月至2010年12月收治诊断EC并行食管切除术的205例患者临床资料进行回顾性分析,根据手术方式将患者分为三野微创食管切除术组(three filed minimally invasive esophagectomy,TMIEG)和开放性食管切除术组(open esophagectomy group,OEG),对患者的一般资料、术后病理学资料、手术情况、术后并发症及Kaplan-Meier生存曲线进行统计学分析。2.对第四军医大学西京消化病医院及唐都医院胸外科2010年1月至2010年12月收治的诊断EC并行食管切除术治疗的患者进行随访,回顾性分析生存期达3年以上患者的生活质量。结果1.一般资料对比显示,两组患者的性别、年龄、吸烟史、肿瘤部位、术前饮食、基础疾病无统计学差异(P0.05);术后病理学资料显示两组患者肿瘤的病理学分型、肿瘤大小、临床T分期和N分期无统计学差异(P0.05);TMIEG患者的手术时间、淋巴结清扫数目显著高于OEG患者(P0.05),术中出血量、术后住院天数较OEG明显降低(P0.05);术后并发症分析显示,TMIEG患者切口感染、心肺并发症例数及总并发症例数显著低于OEG(P0.05);Kaplan-Meier生存曲线分析显示TMIEG患者5年生存率高于OEG(P=0.002)。2.对生存期长于3年患者的资料对比显示,两组患者T分期比较有显著性差异,其余一般临床资料差异无显著性,术后清扫淋巴结总数及淋巴结转移数差异有统计学意义(P0.05),TMIEG患者术中出血量及术后住院天数显著低于OEG(P0.05),两组患者间并发症无明显差异(P0.05),生活质量随访结果显示,TMIEG患者术后3年躯体功能、情绪功能、吞咽困难、进食、反流、恶心呕吐较OEG差异有统计学意义(P0.05)。结论1.TMIE具有可接受的并发症发生率和死亡率,和OE相比,可减少术中出血、缩短术后住院天数、降低手术并发症发生率和死亡率、延长患者生存期。2.TMIE可改善患者的长期预后,术后3年生活质量优于OE。
[Abstract]:Objective esophageal resection is the treatment of esophageal cancer (esophageal cancer EC) is an important means, but the operation is complicated, surgical trauma, postoperative complications are more common, with high mortality. Minimally invasive esophagectomy (minimally invasive esophagectomy, MIE) is the development direction of surgery, with less trauma, faster recovery etc.. Through the research of Sanye minimally invasive esophagectomy (three filed minimally invasive esophagectomy, TMIE) and open esophagectomy (open esophagectomy, OE) compared with the treatment of esophageal cancer, to investigate the clinical effect of TMIE in the treatment of esophageal carcinoma. Methods 1. of The Fourth Military Medical University Xijing Hospital of digestive diseases and the Department of thoracic surgery of Tangdu Hospital from January 2010 to December 2010 the diagnosis of EC parallel esophagectomy in 205 cases were retrospectively analyzed, according to the operation mode, the patients were divided into minimally invasive esophagectomy group (Sanye th REE filed minimally invasive esophagectomy, TMIEG) and open esophagectomy group (open esophagectomy group, OEG), the general data of patients, postoperative pathology, surgery, postoperative complications and survival curve of Kaplan-Meier to follow-up diagnosis EC statistical analysis.2. of The Fourth Military Medical University Xijing Hospital of digestive diseases and the Department of thoracic surgery of Tangdu Hospital from January 2010 to from December 2010 the patients underwent esophagectomy were retrospectively analyzed. The survival time was more than 3 years the quality of life of patients. Results 1. general data show that the two groups of patients with gender, age, smoking history, tumor location, preoperative diet, no significant difference between the basic diseases (P0.05); postoperative pathological data according to the pathological type, two groups of patients with tumor size, clinical T stage and N stage was not statistically significant (P0.05); the operation time of TMIEG patients, lymph node The number of patients with dissection was significantly higher than that of OEG (P0.05), the amount of bleeding, postoperative hospital stay was significantly lower than that in OEG (P0.05); postoperative complications analysis showed that patients with TMIEG infection of incision, complications of lung and heart cases and the total number of patients with complications was significantly lower than that of OEG (P0.05) Kaplan-Meier; survival curve analysis showed that patients with TMIEG 5 year survival rate was higher than that of OEG (P=0.002).2. display comparative data on the survival of patients with more than 3 years, two groups of patients with T staging had significant difference, the rest of the general clinical data had no significant difference, after cleaning the transfer number difference of total number of lymph nodes and lymph node had statistical significance (P0.05), the amount of bleeding and operation after TMIEG patients in hospital stay was significantly lower than that of OEG (P0.05), no significant difference between the two groups of patients, complications (P0.05) follow-up of quality of life showed that the physical function in patients with TMIEG after 3 years of emotional function, dysphagia, regurgitation, nausea, eating. Vomiting is OEG the difference was statistically significant (P0.05). Conclusion 1.TMIE has acceptable complication rate and mortality, compared with OE, can reduce bleeding, shorten postoperative hospital stay, reduce the incidence of surgical complications and mortality, prolong the survival time of patients with long-term prognosis of.2.TMIE can improve the patients, 3 years after operation the quality of life is better than OE.

【学位授予单位】：第四军医大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R735.1

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