摘要目的 比较微创食管癌切除(minimally invasive esophagectomy,MIE)和常规开放食管癌手术治疗食管癌的近期疗效。方法 选择2015-04至2016-10北京武警总医院胸外科收治的食管癌60例,随机分为两组,MIE组30例,常规开胸组30例。比较两组患者手术时间、术中出血量、淋巴结清扫数目、第一次下床时间、肛门排气时间、胸腔引流时间、胸腔引流量、住院时间、术后第5天血常规检查、C反应蛋白及疼痛评估等。结果 两组患者基线特征差异无统计学意义,MIE组患者淋巴结清扫数量与开放组无统计学差异[(18.8±8.6) vs (16.2±8.4), P=0.24]。MIE组患者术中出血量(200±50)ml少于开放组(350±150)ml(P<0.001);MIE组患者术后胸腔引流量少于开放组[(550±200)ml vs (800±350)ml, P<0.001],拔管时间早于开放组[(4.7±1.5)d vs (5.9±1.8)d, P<0.001]。两组患者术后排气时间[(2.1±1.3)d vs (2.3±1.5)d, P=0.27]和下床活动时间[(1.2±0.8)d vs (1.3±0.6)d, P=0.52]无统计学差异。MIE组患者术后住院时间少于开放组[(5.2±1.6)d vs (9.4±1.8)d, P<0.001]。MIE组患者术后24 h、48 h以及72 hVAS评分分别为(2.9±1.1)分、(2.1±1.0)分、(1.5±0.8)分,均低于常规开放组(P<0.001)。结论 MIE显著减少术中出血量,减轻疼痛,缩短术后住院时间。微创可作为食管癌手术治疗的新选择。
Abstract：Objective To compare the short-term efficacy of minimally invasive esophagectomy (MIE) and esophageal carcinoma in the treatment of esophageal cancer.Methods A total of 60 patients with esophageal carcinoma admitted to our hospital between April 2015 and October 2016 were randomly divided into MIE group (30 cases) and esophagectomy group (30 cases). The time of operation, amount of blood loss, number of lymph nodes dissected, time the patient got out of bed for the first time, time of anus exhaust, drainage time of thoracic cavity, drainage volume of thoracic cavity, length of hospital stay, blood routine examinations on day 5, C reaction protein and pain assessment were compared between the two groups after treatment.Results There were no significant differences in baseline characteristics or in the number of lymph nodes dissected [(18.8±8.6) vs (16.2±8.4),P=0.24] between the two groups (P>0.05). MIE patients had a smaller bleeding volume (200±50) ml than those in the esophagectomy group (350 ± 150) ml (P<0.001), as was the case with pleural cavity drainage [(550±200) ml vs (800±350) ml,P<0.001]. Extubation was performed earlier than in the open group [(4.7±1.5) d vs (5.9±1.8) d, P<0.001].There was no significant difference between the two groups in terms of postoperative venting time [(2.1±1.3) d vs (2.3±1.5) d,P=0.27] and ambulation time [(1.2±0.8) d vs (1.3±0.6) d, P=0.52]. In the MIE group, the hospital stay was shorter than that in the open group [(5.2±1.6) d vs (9.4±1.8) d,P<0.001]. The VAS scores of the MIE group were (2.9±1.1), (2.1±1.0) and (1.5±0.8) respectively at 24 h, 48 h and 72 h after operation, which were significantly lower than those of the conventional open group (P<0.001).Conclusions MIE can significantly reduce the amount of bleeding in patients, alleviate pain, and shorten hospital stay after surgery. It can be used as a new surgical therapy for esophageal cancer.
苏立伟, 张冬梅, 李玮, 肖博, 岳泓旭, 贺书, 牛中喜. 微创食管癌切除术与开放食管癌切除术的近期疗效比较[J]. 武警医学, 2017, 28(7): 664-667.
SU Liwei, ZHANG Dongmei, LI Wei, XIAO Bo, YUE Hongxu, HE Shu, and NIU Zhongxi. Comparison of short-term efficacy of minimally invasive esophagectomy and esophagectomy in the treatment of esophageal cancer. Med. J. Chin. Peop. Armed Poli. Forc., 2017, 28(7): 664-667.
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