本文關(guān)鍵詞：三野微創(chuàng)食管切除術(shù)與開(kāi)放手術(shù)治療食管癌臨床療效的對(duì)比研究　出處：《第四軍醫(yī)大學(xué)》2015年碩士論文　論文類(lèi)型：學(xué)位論文

  更多相關(guān)文章： 微創(chuàng)食管切除術(shù) 開(kāi)放性食管切除術(shù) 食管癌

【摘要】：目的食管切除術(shù)是治療食管癌(esophageal cancer,EC)的重要手段,但手術(shù)復(fù)雜,手術(shù)創(chuàng)傷大,術(shù)后并發(fā)癥多見(jiàn),具有很高的死亡率。微創(chuàng)食管切除術(shù)(minimally invasive esophagectomy,MIE)是目前外科的發(fā)展方向,具有創(chuàng)傷小、恢復(fù)快等特點(diǎn)。本研究通過(guò)對(duì)三野微創(chuàng)食管切除術(shù)(three filed minimally invasive esophagectomy,TMIE)與開(kāi)放性食管切除術(shù)(open esophagectomy,OE)治療食管癌的對(duì)比,探討TMIE在治療食管癌中的臨床療效。方法1.對(duì)第四軍醫(yī)大學(xué)西京消化病醫(yī)院及唐都醫(yī)院胸外科2010年1月至2010年12月收治診斷EC并行食管切除術(shù)的205例患者臨床資料進(jìn)行回顧性分析,根據(jù)手術(shù)方式將患者分為三野微創(chuàng)食管切除術(shù)組(three filed minimally invasive esophagectomy,TMIEG)和開(kāi)放性食管切除術(shù)組(open esophagectomy group,OEG),對(duì)患者的一般資料、術(shù)后病理學(xué)資料、手術(shù)情況、術(shù)后并發(fā)癥及Kaplan-Meier生存曲線進(jìn)行統(tǒng)計(jì)學(xué)分析。2.對(duì)第四軍醫(yī)大學(xué)西京消化病醫(yī)院及唐都醫(yī)院胸外科2010年1月至2010年12月收治的診斷EC并行食管切除術(shù)治療的患者進(jìn)行隨訪,回顧性分析生存期達(dá)3年以上患者的生活質(zhì)量。結(jié)果1.一般資料對(duì)比顯示,兩組患者的性別、年齡、吸煙史、腫瘤部位、術(shù)前飲食、基礎(chǔ)疾病無(wú)統(tǒng)計(jì)學(xué)差異(P0.05);術(shù)后病理學(xué)資料顯示兩組患者腫瘤的病理學(xué)分型、腫瘤大小、臨床T分期和N分期無(wú)統(tǒng)計(jì)學(xué)差異(P0.05);TMIEG患者的手術(shù)時(shí)間、淋巴結(jié)清掃數(shù)目顯著高于OEG患者(P0.05),術(shù)中出血量、術(shù)后住院天數(shù)較OEG明顯降低(P0.05);術(shù)后并發(fā)癥分析顯示,TMIEG患者切口感染、心肺并發(fā)癥例數(shù)及總并發(fā)癥例數(shù)顯著低于OEG(P0.05);Kaplan-Meier生存曲線分析顯示TMIEG患者5年生存率高于OEG(P=0.002)。2.對(duì)生存期長(zhǎng)于3年患者的資料對(duì)比顯示,兩組患者T分期比較有顯著性差異,其余一般臨床資料差異無(wú)顯著性,術(shù)后清掃淋巴結(jié)總數(shù)及淋巴結(jié)轉(zhuǎn)移數(shù)差異有統(tǒng)計(jì)學(xué)意義(P0.05),TMIEG患者術(shù)中出血量及術(shù)后住院天數(shù)顯著低于OEG(P0.05),兩組患者間并發(fā)癥無(wú)明顯差異(P0.05),生活質(zhì)量隨訪結(jié)果顯示,TMIEG患者術(shù)后3年軀體功能、情緒功能、吞咽困難、進(jìn)食、反流、惡心嘔吐較OEG差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論1.TMIE具有可接受的并發(fā)癥發(fā)生率和死亡率,和OE相比,可減少術(shù)中出血、縮短術(shù)后住院天數(shù)、降低手術(shù)并發(fā)癥發(fā)生率和死亡率、延長(zhǎng)患者生存期。2.TMIE可改善患者的長(zhǎng)期預(yù)后,術(shù)后3年生活質(zhì)量?jī)?yōu)于OE。
[Abstract]:Objective esophageal resection is the treatment of esophageal cancer (esophageal cancer EC) is an important means, but the operation is complicated, surgical trauma, postoperative complications are more common, with high mortality. Minimally invasive esophagectomy (minimally invasive esophagectomy, MIE) is the development direction of surgery, with less trauma, faster recovery etc.. Through the research of Sanye minimally invasive esophagectomy (three filed minimally invasive esophagectomy, TMIE) and open esophagectomy (open esophagectomy, OE) compared with the treatment of esophageal cancer, to investigate the clinical effect of TMIE in the treatment of esophageal carcinoma. Methods 1. of The Fourth Military Medical University Xijing Hospital of digestive diseases and the Department of thoracic surgery of Tangdu Hospital from January 2010 to December 2010 the diagnosis of EC parallel esophagectomy in 205 cases were retrospectively analyzed, according to the operation mode, the patients were divided into minimally invasive esophagectomy group (Sanye th REE filed minimally invasive esophagectomy, TMIEG) and open esophagectomy group (open esophagectomy group, OEG), the general data of patients, postoperative pathology, surgery, postoperative complications and survival curve of Kaplan-Meier to follow-up diagnosis EC statistical analysis.2. of The Fourth Military Medical University Xijing Hospital of digestive diseases and the Department of thoracic surgery of Tangdu Hospital from January 2010 to from December 2010 the patients underwent esophagectomy were retrospectively analyzed. The survival time was more than 3 years the quality of life of patients. Results 1. general data show that the two groups of patients with gender, age, smoking history, tumor location, preoperative diet, no significant difference between the basic diseases (P0.05); postoperative pathological data according to the pathological type, two groups of patients with tumor size, clinical T stage and N stage was not statistically significant (P0.05); the operation time of TMIEG patients, lymph node The number of patients with dissection was significantly higher than that of OEG (P0.05), the amount of bleeding, postoperative hospital stay was significantly lower than that in OEG (P0.05); postoperative complications analysis showed that patients with TMIEG infection of incision, complications of lung and heart cases and the total number of patients with complications was significantly lower than that of OEG (P0.05) Kaplan-Meier; survival curve analysis showed that patients with TMIEG 5 year survival rate was higher than that of OEG (P=0.002).2. display comparative data on the survival of patients with more than 3 years, two groups of patients with T staging had significant difference, the rest of the general clinical data had no significant difference, after cleaning the transfer number difference of total number of lymph nodes and lymph node had statistical significance (P0.05), the amount of bleeding and operation after TMIEG patients in hospital stay was significantly lower than that of OEG (P0.05), no significant difference between the two groups of patients, complications (P0.05) follow-up of quality of life showed that the physical function in patients with TMIEG after 3 years of emotional function, dysphagia, regurgitation, nausea, eating. Vomiting is OEG the difference was statistically significant (P0.05). Conclusion 1.TMIE has acceptable complication rate and mortality, compared with OE, can reduce bleeding, shorten postoperative hospital stay, reduce the incidence of surgical complications and mortality, prolong the survival time of patients with long-term prognosis of.2.TMIE can improve the patients, 3 years after operation the quality of life is better than OE.

【學(xué)位授予單位】：第四軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R735.1

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