摘要目的 探讨胸腔镜食管癌根治术的安全性.方法 回顾性分析2005年1月至2012年3月间复旦大学附属中山医院胸外科收治的胸腔镜食管癌根治术(260例)和常规开胸三切口食管癌根治术(322例)患者的临床资料.比较两组手术相关指标、围手术期并发症、冉次手术、冉入ICU及其转归.结果 与开胸组相比,胸腔镜组患者胸部手术时间更短[(105±30) min比(112±41)min,P=0.000],胸部出血量更少[(95±48) ml比(107±44) ml,P=0.002],术后住院时间更短[(14.3±7.5)d比(16.9±9.5)d,P=0.000],胸部淋巴结清扫数量更多[(13.5±5.0)d比(11.6±4.7)d,P=0.000],围手术期并发症发生率更低[34.6％ (90/260)比45.0％(145/322),P=0.011),围手术期死亡率更低[0.8％(2/260)比3.4％( 11/322),P=0.032).两组患者术后再次手术的比例相当[1.5％( 4/260)比2.5％(8/322),P=0.425),但胸腔镜组术后需要冉入ICU者明显更少[5.4％( 14/260)比10.6％ (34/322),P=0.024).结论 与开胸手术相比,胸腔镜食管癌根治术在安全性方面具有一定的优势.

abstractsObjective To explore the safety of video-assisted thoracoscopic esophagectomy for esophageal carcinoma.Methods From January 2005 to March 2012,260 patients with esophageal carcinoma received thoracoscopic esophagectomy(TE group),while 322 patients underwent conventional open esophagectomy (OE group).Operative procedures,perioperative complications,reoperation,readmission to intensive care unit (ICU),and perioperative mortality were compared between the two groups.Results Compared with OE group,TE group possessed less thoracic operative time[ (105±30)min vs.( 112±41 ) min,P=0.000],less blood loss[(95±48) ml vs.(107±44) ml,P=0.002],shorter postoperative hospital stay [(14.3±7.5) d vs.(16.9±9.5) d,P=0.000]and more lymph node harvest from thorax[(13.5±5.0) vs.(11.6±4.7),P=0.000].The total perioperative complication rate was lower in TE group than that of OE group (34.6％ vs.45.0％,P=0.011),as well as perioperative mortality (0.8％ vs.3.4％,P=0.032).Lower rate of readmission to ICU (5.4％ vs.10.6％,P=0.024) was found in the TE group as compared to the OE group,while the reoperation rate was comparable (1.5％ vs.2.5％,P=0.425).Conclusion Thoracoscopic esophagectomy is advantageous than open procedure in terms of surgical safety.