本文選題：食管癌　切入點：微創(chuàng)　出處：《青島大學》2017年碩士論文

【摘要】：目的:對比分析電視胸腔鏡聯(lián)合腹腔鏡微創(chuàng)食管癌切除右胸內(nèi)吻合與左頸部吻合治療胸中下段食管癌的效果及優(yōu)缺點。方法:對我院胸外科2014年9月至2016年12月80例電視胸腔鏡聯(lián)合腹腔鏡胸中、下段食管癌根治術(shù)患者的臨床資料進行回顧性分析,其中胸下段食管癌46例,胸中段食管癌34例,根據(jù)手術(shù)方法不同將80例患者分為右胸內(nèi)吻合組及左頸部吻合組。右胸內(nèi)吻合38例,包括胸下段食管癌24例、胸中段食管癌14例;左頸部吻合42例,包括胸下段食管癌22例、胸中段食管癌20例。評價指標包括:手術(shù)時間、術(shù)中出血量、平均清掃淋巴結(jié)數(shù)、平均清掃上縱隔淋巴結(jié)數(shù)、總淋巴結(jié)轉(zhuǎn)移率、術(shù)后放管時間、術(shù)后進食時間、術(shù)后住院時間、住院費用,術(shù)后并發(fā)癥如食管胃吻合口瘺或管胃瘺、肺部感染、喉返神經(jīng)損傷、乳糜胸、切口感染、心律失常、乳糜胸發(fā)生、胃排空障礙等。結(jié)果:兩組患者臨床病理學特征比較差異無統(tǒng)計學意義。右胸內(nèi)吻合組手術(shù)時間、術(shù)后住院時間與左頸部吻合組比較差異無統(tǒng)計學意義(P0.05)。右胸內(nèi)吻合組術(shù)后胸管、胃管放置時間,術(shù)后進食時間較左頸部吻合組長(P0.05);在術(shù)中出血量、平均清掃淋巴結(jié)數(shù)、平均清掃上縱隔淋巴結(jié)數(shù)、總淋巴結(jié)轉(zhuǎn)移率、手術(shù)費用方面比較兩組差異無統(tǒng)計學意義(P0.05)。右胸內(nèi)吻合組的肺部感染、喉返神經(jīng)損傷和吻合口瘺發(fā)生率較左頸部吻合組低(P0.05);兩組間術(shù)后心律失常、切口感染、乳糜胸發(fā)生、胃排空障礙比較差異無統(tǒng)計學意義(P0.05)。兩組患者共隨訪78例(97.5%),隨訪時間為1-26個月,平均為(12.5±6.7)個月,中位隨訪時間為11個月。兩組患者隨訪期間的主訴不適癥狀、術(shù)后放化療、腫瘤局部復(fù)發(fā)率或遠處轉(zhuǎn)移率、吻合口狹窄、死亡及總生存率等方面差異無統(tǒng)計學意義。結(jié)論:在胸中下段食管癌微創(chuàng)手術(shù)治療方面,右胸內(nèi)吻合和左頸部吻合一樣的安全性,可徹底清掃區(qū)域淋巴結(jié)及術(shù)后準確病理分期,但術(shù)后吻合口瘺、喉返神經(jīng)損傷和肺部感染發(fā)生率更低,并發(fā)癥明顯少于左頸部。兩組患者的生活質(zhì)量(術(shù)后吻合口狹窄、返流等)比較,腫瘤復(fù)發(fā)轉(zhuǎn)移及近期生存率比較無統(tǒng)計學差異,具有良好的近期療效,安全、可行。
[Abstract]:Objective: to compare the effect of video-assisted thoracoscopy and laparoscopic minimally invasive resection of esophageal carcinoma with right intrathoracic anastomosis and left cervical anastomosis in the treatment of middle and lower thoracic esophageal carcinoma.Methods: from September 2014 to December 2016, the clinical data of 80 patients undergoing thoracoscopic thoracoscopy combined with laparoscopy for radical resection of lower esophageal carcinoma were retrospectively analyzed, including 46 cases of lower thoracic esophageal carcinoma and 34 cases of middle thoracic esophageal carcinoma.80 patients were divided into right thoracic anastomosis group and left neck anastomosis group according to different surgical methods.Right intrathoracic anastomosis was performed in 38 cases, including 24 cases of lower thoracic esophageal carcinoma, 14 cases of middle thoracic esophageal carcinoma, 42 cases of left cervical anastomosis, including 22 cases of lower thoracic esophageal carcinoma and 20 cases of middle thoracic esophageal carcinoma.The evaluation indexes included: operation time, intraoperative bleeding volume, average number of lymph nodes dissected, average number of upper mediastinal lymph nodes dissected, total lymph node metastasis rate, postoperative time of tube placement, postoperative feeding time, postoperative hospitalization time, hospitalization expenses.Postoperative complications such as esophagogastric anastomotic fistula or tube gastric fistula lung infection recurrent laryngeal nerve injury chylothorax incision infection arrhythmia chylothorax gastric emptying and so on.Results: there was no significant difference in clinicopathological features between the two groups.There was no significant difference in operation time and hospital stay between the right thoracic anastomosis group and the left cervical anastomosis group (P 0.05).There was no significant difference in operation cost between the two groups (P 0.05).The incidence of pulmonary infection, recurrent laryngeal nerve injury and anastomotic leakage in the right thoracic anastomosis group was lower than that in the left cervical anastomosis group (P 0.05), but there was no significant difference in postoperative arrhythmia, incision infection, chylothorax and gastric emptying disorder between the two groups.A total of 78 patients in the two groups were followed up for 1 to 26 months (mean 12.5 鹵6.7) months, with a median follow-up time of 11 months.Conclusion: in the minimally invasive surgical treatment of middle and lower thoracic esophageal carcinoma, right intrathoracic anastomosis is as safe as left cervical anastomosis, regional lymph nodes can be completely dissected and accurate pathological stages can be obtained after operation, but anastomotic leakage after operation.The incidence of recurrent laryngeal nerve injury and pulmonary infection was lower and complications were significantly lower than those of left neck.The quality of life (anastomotic stenosis, reflux, etc.), recurrence and metastasis of tumor and short-term survival rate were not significantly different between the two groups, and had good short-term curative effect, safety and feasibility.
【學位授予單位】：青島大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R735.1

【參考文獻】

相關(guān)期刊論文 前10條

1 范玉慧;郭石平;杜小祥;王云飛;;食管癌微創(chuàng)外科治療的現(xiàn)狀與進展[J];中華臨床醫(yī)師雜志(電子版);2015年06期

2 張旭剛;李維青;李志田;戈烽;;OrVil系統(tǒng)行胸腹腔鏡聯(lián)合Ivor-Lewis食管癌根治術(shù)臨床分析[J];重慶醫(yī)學;2015年03期

3 宋永彬;柳立軍;;全腔鏡下Ivor Lewis食管癌根治術(shù)釘砧安置的新方法[J];中國微創(chuàng)外科雜志;2015年01期

4 孫翔翔;徐美清;郭明發(fā);柳常青;魏大中;馬冬春;徐世斌;梅新宇;田介勇;張正華;;電視胸腔鏡下食管癌根治并胸內(nèi)吻合術(shù)60例[J];中國胸心血管外科臨床雜志;2013年05期

5 潘華光;胡旭;于在誠;柴惠平;劉曉;宋德勝;康寧寧;車云;葛威;張仁泉;;胸腹腔鏡聯(lián)合食管癌根治術(shù)學習曲線分析[J];中華胸心血管外科雜志;2013年06期

6 艾波;廖永德;付向?qū)?;全胸腔鏡下食管胃胸內(nèi)吻合術(shù)治療中下段食管癌的技術(shù)探討[J];中國微創(chuàng)外科雜志;2013年05期

7 左曉飛;牛中喜;時輝;胡楊;王允;陳龍奇;;食管癌切除術(shù)后胸胃-氣管/支氣管瘺的防治經(jīng)驗與教訓[J];中華胸心血管外科雜志;2013年03期

8 黃宏雙;趙波;;電視胸腔鏡手術(shù)在胸部腫瘤治療中的應(yīng)用[J];新鄉(xiāng)醫(yī)學院學報;2013年02期

9 張雪飛;張煒;韓彪;;食管癌術(shù)后吻合口瘺的研究進展[J];醫(yī)學綜述;2012年22期

10 傅劍華;;以分期為基礎(chǔ)的食管癌微創(chuàng)治療[J];中華胃腸外科雜志;2012年09期

，

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