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胸腔镜和腹腔镜联合手术与开放手术治疗食管癌的回顾性队列研究

A retrospective cohort comparison of esophageal carcinoma between thoracoscopic and laparoscopic esophagectomy and open esophagectomy

摘要:

目的 比较胸腔镜与腹腔镜联合手术与开放手术治疗食管癌的疗效差异.方法 对2011年3月至2014年3月江苏省泰兴市人民医院胸外科62例胸腔镜与腹腔镜联合手术患者(腔镜组)和62例开放手术的患者(开放组)的临床资料进行分析.两组均为男性45例,女性17例;平均年龄分别为(62±9)岁和(62 ±8)岁.两组患者在年龄、肿瘤部位、病理类型及肿瘤分期等方面差异均无统计学意义.收集围手术期相关指标,同时随访3年生存情况.t检验和x2检验比较两组一般资料,Kaplan-Meier法绘制生存曲线,采用Log-rank检验进行生存率比较.结果 腔镜组的术中出血量[(231 ±40) ml比(302±37) ml,t=4.63,P=0.000]、术后胸腔引流量[(490±41) ml比(1 090±43) ml,t=-79.59,P=0.000]和术后住院时间[(16±4)d比(17±4)d,t=-2.61,P=0.010]低于开放组;手术时间[(272±39) min比(242±45) min,t =3.97,P=0.000]、淋巴结清扫数目[(30±5)个比(28±4)个,t=2.39,P=0.018]和胸部淋巴结清扫数目[(15±4)个比(14 ±3)个,t=2.59,P=0.011]高于开放组.两组分别有19例和31例发生术后并发症,差异有统计学意义(x2=4.83,P=0.028).腔镜组3年累积生存率为73.2%,开放组为71.4%,差异无统计学意义(x2=0.170,P>0.05).结论 胸腹腔镜联合治疗食管癌在出血量、住院时间和并发症等方面优于开放手术,但3年累积生存率无统计学差异.

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abstracts:

Objective To study the efficacy and safety of thoracoscopic and laparoscopic esophagectomy for esophageal carcinoma.Methods Based on hospitalization data from March 2011 to March 2014,62 cases of esophageal carcinoma treated with thoracoscopic and laparoscopic esophagectomy (minimally invasive group,with 45 male patients) and other 62 cases treated with open esophagectomy (open esophagectomy group,with 45 male patients) were analyzed in a retrospective cohort.The mean age of two groups were (62 ± 9) years and (62 ± 8) years,respectively.Quantitative data were analyzed using t-test,whereas qualitative variables were tested with x2 test.There were no significant difference in age,tumor location,pathological type,tumor staging between two groups (P > 0.05).Perioperative data and three-year clinic outcome were collected.The three-year survival curve were calculated with the KaplanMeier method and compared by the log-rank test between the two groups.Results Compared with open esophagectomy group,minimally invasive group has less amount of bleeding during operations ((231 ± 40) ml vs.(302 ± 37) ml,t =4.63,P =0.000),pleural drainage after operations ((490 ± 41) ml vs.(1 090 ± 43) ml,t =-79.59,P =0.000),and postoperative hospital stay ((16 ± 4) days vs.(17 ± 4) days,t =-2.61,P =0.010).Meanwhile,minimally invasive group has more operation time ((272 ± 39) minutes vs.(242 ± 45) minutes,t =3.97,P =0.000) and total and thoracic cavity retrieved lymph nodes (30±5vs.28±4,t=2.39,P=0.018;15 ±4 vs.14±3,t=2.59,P=0.011).Nineteen and 31 patients had postoperative complications and statistical significance difference was found between two groups (x2 =4.83,P =0.028).The three-year survival rate was 73.2% in minimally invasive group and 71.4% in open esophagectomy group.There was no significance difference between two groups (x2 =0.170,P > 0.05).Conclttsion Thoracoscopic and laparoscopic esophagectomy had the advantages of amount of bleeding,postoperative hospital stay and complications,and had the same three-year survival rate with open esophagectomy.

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