本文選題：食管癌　切入點(diǎn)：腹腔鏡　出處：《廣西醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:探討胸腹腔鏡聯(lián)合Ivor-Lewis食管癌根治術(shù)(Minimally Invasive Ivor-Lewis Esophagectomy,MIILE)治療胸中、下段食管鱗癌的安全性、可行性和近期療效。方法:回顧性分析2013年6月至2016年10月四川省腫瘤醫(yī)院胸外科一個(gè)病區(qū)經(jīng)上腹-右胸路徑食管癌根治術(shù)的147例患者的臨床資料,其中MIILE術(shù)式65例,開放Ivor-Lewis食管癌根治術(shù)(Open Ivor-Lewis Esophagectomy,ILE)82例,對(duì)比兩組患者的圍手術(shù)期指標(biāo)、術(shù)后并發(fā)癥發(fā)生率、術(shù)后疼痛評(píng)分以及術(shù)后生存率。結(jié)果:兩組患者術(shù)前一般情況、腫瘤分期、術(shù)前合并癥、術(shù)中出血量、平均淋巴結(jié)清掃數(shù)、術(shù)后拔管時(shí)間、進(jìn)食時(shí)間、吻合口瘺、生存率比較無(wú)統(tǒng)計(jì)學(xué)差異。MIILE組手術(shù)時(shí)間較長(zhǎng)(289.6±32.3min vs.260.8±26.3 min,P0.001),住院總費(fèi)用較高(88030.9±8578.3元vs.80852.4±6014.3元,P0.001),術(shù)后住院時(shí)間較短(11.5±3.6d vs.13.0±4.5d,P=0.005),喉返神經(jīng)損傷/麻痹發(fā)生率較低(4.6%vs.14.6%,P=0.046),肺部感染發(fā)生率較低(12.3%vs.25.6%,P=0.044),術(shù)后24h、48h、72h、1月疼痛評(píng)分較低(3.1±0.8 vs.4.2±0.9,3.9±0.9 vs.4.7±1.0,3.4±0.8 vs.4.6±0.9,2.7±0.7 vs.3.5±1.2,P0.001)。結(jié)論:MIILE術(shù)式具有安全性和可行性。MIILE術(shù)式手術(shù)時(shí)間較長(zhǎng),住院費(fèi)用較高,但術(shù)后住院時(shí)間短,疼痛較輕,喉返神經(jīng)損傷/麻痹和肺部感染發(fā)生率較低。因此,對(duì)分期在IIIA期以前,無(wú)頸部淋巴結(jié)轉(zhuǎn)移的胸中、下段食管鱗癌患者,可首先考慮MIILE術(shù)式。
[Abstract]:Objective: to investigate the safety of thoracoscopic laparoscopy combined with radical resection of esophageal carcinoma with Ivor-Lewis in the treatment of middle and lower esophageal squamous cell carcinoma. Methods: from June 2013 to October 2016, the clinical data of 147 patients undergoing radical resection of esophageal carcinoma via epigastric and right thoracic pathway in a thoracic surgery area of Sichuan Cancer Hospital were analyzed retrospectively, including 65 cases of MIILE operation. There were 82 patients with open Ivor-Lewis esophageal carcinoma undergoing open Ivor-Lewis esophagectomy. The perioperative index, postoperative complication rate, postoperative pain score and postoperative survival rate were compared between the two groups. Results: the preoperative general condition, tumor stage, preoperative complications and complications were compared between the two groups. Intraoperative bleeding, mean lymph node dissection, extubation time, feeding time, anastomotic leakage, The survival rate of MIILE group was longer than that of 289.6 鹵32.3min vs.260.8 鹵26.3 min P0.001M, the total cost of hospitalization was 88030.9 鹵8578.3 vs.80852.4 鹵6014.3 vs.80852.4 鹵6014.3 yuan P0.001L, the postoperative hospitalization time was shorter 11.5 鹵3.6d 鹵4.5dP0.005D, the incidence of recurrent laryngeal nerve injury / paralysis was lower than 4.6vs.14.6Vs.14.6P0.046m, the incidence of pulmonary infection was lower than 12.3vs.25.6vs.25.6Vs.25.60.44. The pain score in January was 3.1 鹵0.8 vs.4.2 鹵0.9 vs.4.7 鹵0.9 vs.4.7 鹵0.9 vs.4.6 鹵0.9 vs.4.6 鹵0.9 vs.4.6 鹵0.9 vs.4.6 鹵0.7 vs.3.5 鹵1.2 P0.0010.Conclusion it is safe and feasible. The cost of hospitalization was higher, but the postoperative hospitalization time was short, the pain was mild, the incidence of recurrent laryngeal nerve injury / paralysis and pulmonary infection was lower. The MIILE procedure can be considered first.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735.1

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