【摘要】 目的探讨胸腹腔镜联合微创食管癌根治术(minimally invasive esophagectomy,MIE)对比传统开胸术(open esophagectomy,OE)治疗高龄食管癌(≥70岁)的临床效果,为临床应用微创手术治疗高龄食管癌提供理论依据。方法随机挑选实施MIE及OE手术的高龄患者各52例进行回顾性分析及总结。结果 MIE全组均胸腹腔镜下顺利完成,无中转开胸,其手术时间平均(261.4±35.2)min与OE组(249.0±37.0)min相比差异无统计学意义(P>0.05)。两组术中出血分别为约(190.1±86.8)ml、(391.35±118.5)ml,差异具有统计学意义(P<0.05)。MIE组术后WBC、CRP指标及术后疼痛评估均优于OE组(P<0.05)。两组吻合口瘘、喉返神经损伤及乳糜胸差异无统计学意义,但肺部感染、呼吸衰竭及心律失常发生率MIE组低于OE组(P<0.05)。MIE组住院时间少于OE组(P<0.05)。术后平均随访(22.1±11.1)月,两者生存时间差异无统计学意义(P=0.979)。结论 MIE可显著减轻高龄患者术后疼痛以及全身炎性反应,降低心肺系统等相关并发症的发生率,缩短住院时间,有利于高龄食管癌患者术后快速康复更多还原

【Abstract】 Objective To compare the clinical effect of minimally invasive esophagectomy(MIE) versus open esophagectomy(OE) on elderly esophageal carcinoma patients(≥70 years old), to provide the relevant theoretical basis for the clinical application of minimally invasive surgery on esophageal carcinoma. Methods We retrospectively reviewed the data of the randomly-selected elderly patients who underwent MIE or OE(each 52) in the Department of Thoracic Surgery. Results The MIE group was successfully performed under thoracoscopy and laparoscopy without conversion to open esophagectomy. The mean operation time were(261.4±35.2) and(249.0±37.0)min in MIE and OE groups(P>0.05). The intraoperative blood loss on average were respectively about(190.1±86.8) and(391.35±118.5)ml in MIE and OE groups(P<0.05). The white blood cell(WBC), C-reactive protein(CRP) and postoperative pain evaluation were better in the MIE group than those in the OE group(P<0.05). There was no signifi cant difference in anastomotic fi stula, recurrent laryngeal nerve injury or chylothorax between the two groups, but the incidence of pulmonary infection, respiratory failure and arrhythmia in MIE group was lower than those in OE group(P<0.05). The hospitalization time in MIE group was less than that in OE group(P<0.05). The patients were followed up for(22.1±11.1) months, there was no signifi cant difference in survival time between the two groups(P=0.985). Conclusion Clinical application of MIE could signifi cantly reduce the elderly patients’ postoperative pain, systemic infl ammatory response, the incidence of complications such as cardiopulmonary system, as well as the length of hospital stay. It is conducive to rapid recovery of elderly esophageal cancer patients.更多还原