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目的对比分析全胸腔镜食管癌根治术和常规剖胸食管癌根治术在食管癌手术中的应用效果及安全性,旨在为今后临床更合理选择手术方案提供参考和借鉴。方法前瞻性选取2014年1月—2016年1月期间胸外科收治的120例食管癌手术患者,采用随机数字表法将其分为2组,每组60例,胸腔镜组行全胸腔镜食管癌根治术,开胸组则行常规剖胸食管癌根治术,对比两组患者手术情况、术后恢复情况及并发症发生情况。结果胸腔镜组中8例中转剖胸手术,胸腔探查肿瘤情况评估不宜行胸腔镜手术3例,5例患者胸腔粘连严重,镜下操作困难,不能彻底游离食管,中转率为13.33%,剖胸食管癌根治术患者均顺利完成手术。胸腔镜组手术时间明显长于剖胸组(P<0.05),术中出血量明显少于开胸组(P<0.05),淋巴结清扫组数腔镜组较开胸组明显较多,清扫范围相对广,差异无统计学意义(P>0.05);胸腔镜组患者胸液引流量、引流时间、疼痛VAS评分、住院时间均明显小于剖胸组(P<0.05);全胸腔镜组并发症发生率为9.62%明显低于剖胸组的27.94%(P<0.05)。结论全胸腔镜食管癌根治术在早中期食管癌患者可到达剖胸食管癌根治术根治效果,减少术中出血量,降低术后并发症发生率,恢复较快,可作为首选的手术方案。
Objective To compare and analyze the application and safety of thoracoscopic esophageal cancer radical mastectomy and conventional thoracotomy esophageal cancer radical mastectomy in the surgical treatment of esophageal cancer so as to provide reference and reference for more rational clinical choice of surgical programs in the future. Methods A total of 120 esophageal cancer patients who underwent thoracic surgery from January 2014 to January 2016 were prospectively selected. The patients were divided into two groups (n = 60 in each group) by random number table method. The thoracoscopic group underwent thoracoscopic esophageal Radical mastectomy and thoracotomy group underwent routine thoracotomy for esophagectomy. The operative conditions, postoperative recovery and complication were compared between the two groups. Results In the thoracoscopic group, 8 cases underwent thoracotomy, thoracoscopic exploration of the tumor should not be performed under thoracoscopic surgery in 3 cases, 5 cases had severe thoracic adhesions and difficult operation under the microscope. The esophagus could not completely esophageal esophagus. The conversion rate was 13.33% Esophageal cancer patients underwent radical surgery. The operation time of thoracoscopic group was significantly longer than that of thoracotomy group (P <0.05), and the amount of bleeding during operation was significantly less than that of thoracotomy group (P <0.05). The number of laparoscopic group was significantly higher than that of thoracotomy group (P> 0.05). Thoracic drainage, drainage time, pain VAS score and hospital stay in thoracoscopic group were significantly lower than those in thoracotomy group (P <0.05). The complications of thoracoscopic group The rate of 9.62% was significantly lower than that of the thoracotomy group (27.94%, P <0.05). Conclusion Thoracoscopic esophageal cancer radical surgery in early and mid esophageal cancer patients can reach the thoracotomy esophageal radical cure, reduce the amount of intraoperative bleeding, reduce the incidence of postoperative complications, recovery quickly, can be used as the preferred surgical options.