微创食管癌切除胸内吻合与颈部吻合对比研究

发布时间：2018-04-09 11:05

本文选题：食管癌　切入点：微创　出处：《青岛大学》2017年硕士论文

【摘要】：目的:对比分析电视胸腔镜联合腹腔镜微创食管癌切除右胸内吻合与左颈部吻合治疗胸中下段食管癌的效果及优缺点。方法:对我院胸外科2014年9月至2016年12月80例电视胸腔镜联合腹腔镜胸中、下段食管癌根治术患者的临床资料进行回顾性分析,其中胸下段食管癌46例,胸中段食管癌34例,根据手术方法不同将80例患者分为右胸内吻合组及左颈部吻合组。右胸内吻合38例,包括胸下段食管癌24例、胸中段食管癌14例;左颈部吻合42例,包括胸下段食管癌22例、胸中段食管癌20例。评价指标包括:手术时间、术中出血量、平均清扫淋巴结数、平均清扫上纵隔淋巴结数、总淋巴结转移率、术后放管时间、术后进食时间、术后住院时间、住院费用,术后并发症如食管胃吻合口瘘或管胃瘘、肺部感染、喉返神经损伤、乳糜胸、切口感染、心律失常、乳糜胸发生、胃排空障碍等。结果:两组患者临床病理学特征比较差异无统计学意义。右胸内吻合组手术时间、术后住院时间与左颈部吻合组比较差异无统计学意义(P0.05)。右胸内吻合组术后胸管、胃管放置时间,术后进食时间较左颈部吻合组长(P0.05);在术中出血量、平均清扫淋巴结数、平均清扫上纵隔淋巴结数、总淋巴结转移率、手术费用方面比较两组差异无统计学意义(P0.05)。右胸内吻合组的肺部感染、喉返神经损伤和吻合口瘘发生率较左颈部吻合组低(P0.05);两组间术后心律失常、切口感染、乳糜胸发生、胃排空障碍比较差异无统计学意义(P0.05)。两组患者共随访78例(97.5%),随访时间为1-26个月,平均为(12.5±6.7)个月,中位随访时间为11个月。两组患者随访期间的主诉不适症状、术后放化疗、肿瘤局部复发率或远处转移率、吻合口狭窄、死亡及总生存率等方面差异无统计学意义。结论:在胸中下段食管癌微创手术治疗方面,右胸内吻合和左颈部吻合一样的安全性,可彻底清扫区域淋巴结及术后准确病理分期,但术后吻合口瘘、喉返神经损伤和肺部感染发生率更低,并发症明显少于左颈部。两组患者的生活质量(术后吻合口狭窄、返流等)比较,肿瘤复发转移及近期生存率比较无统计学差异,具有良好的近期疗效,安全、可行。
[Abstract]:Objective: to compare the effect of video-assisted thoracoscopy and laparoscopic minimally invasive resection of esophageal carcinoma with right intrathoracic anastomosis and left cervical anastomosis in the treatment of middle and lower thoracic esophageal carcinoma.Methods: from September 2014 to December 2016, the clinical data of 80 patients undergoing thoracoscopic thoracoscopy combined with laparoscopy for radical resection of lower esophageal carcinoma were retrospectively analyzed, including 46 cases of lower thoracic esophageal carcinoma and 34 cases of middle thoracic esophageal carcinoma.80 patients were divided into right thoracic anastomosis group and left neck anastomosis group according to different surgical methods.Right intrathoracic anastomosis was performed in 38 cases, including 24 cases of lower thoracic esophageal carcinoma, 14 cases of middle thoracic esophageal carcinoma, 42 cases of left cervical anastomosis, including 22 cases of lower thoracic esophageal carcinoma and 20 cases of middle thoracic esophageal carcinoma.The evaluation indexes included: operation time, intraoperative bleeding volume, average number of lymph nodes dissected, average number of upper mediastinal lymph nodes dissected, total lymph node metastasis rate, postoperative time of tube placement, postoperative feeding time, postoperative hospitalization time, hospitalization expenses.Postoperative complications such as esophagogastric anastomotic fistula or tube gastric fistula lung infection recurrent laryngeal nerve injury chylothorax incision infection arrhythmia chylothorax gastric emptying and so on.Results: there was no significant difference in clinicopathological features between the two groups.There was no significant difference in operation time and hospital stay between the right thoracic anastomosis group and the left cervical anastomosis group (P 0.05).There was no significant difference in operation cost between the two groups (P 0.05).The incidence of pulmonary infection, recurrent laryngeal nerve injury and anastomotic leakage in the right thoracic anastomosis group was lower than that in the left cervical anastomosis group (P 0.05), but there was no significant difference in postoperative arrhythmia, incision infection, chylothorax and gastric emptying disorder between the two groups.A total of 78 patients in the two groups were followed up for 1 to 26 months (mean 12.5 卤6.7) months, with a median follow-up time of 11 months.Conclusion: in the minimally invasive surgical treatment of middle and lower thoracic esophageal carcinoma, right intrathoracic anastomosis is as safe as left cervical anastomosis, regional lymph nodes can be completely dissected and accurate pathological stages can be obtained after operation, but anastomotic leakage after operation.The incidence of recurrent laryngeal nerve injury and pulmonary infection was lower and complications were significantly lower than those of left neck.The quality of life (anastomotic stenosis, reflux, etc.), recurrence and metastasis of tumor and short-term survival rate were not significantly different between the two groups, and had good short-term curative effect, safety and feasibility.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.1

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